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Coronary Arteriovenous Fistula

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Presentation on theme: "Coronary Arteriovenous Fistula"— Presentation transcript:

1 Coronary Arteriovenous Fistula
Ali Sepahdari, MD 4/6/07

2 Cardiomegaly, increased vascularity, atrial enlargement

3 Fundamental CXR approach
Vessels -> Heart size INCREASED NORMAL OR DECREASED ENLARGED VSD, ASD, PDA, PAPVC, other, TGA, truncus, TAPVC, TA, single vent, DORV, DOLV, HLH, multiple pulm AVM’s Ebstein’s, Pulm sten, TA w/ restr. ASD, PA w/ intact IVS, transient TR NORMAL OR SMALL TAPR TOF; Pulm stenosis and VSD with: TGA, DOR/LV; hypoplastic RV, TR w/ ASD and pulm sten

4 Further subdivision… VSD, ASD, PDA, PAPVC, other
TGA, truncus, TAPVC, TA, single vent, DORV, DOLV, HLH, multiple pulm AVM’s

5 Noncyanotic disease Is there left atrial enlargement?
If yes, then consider VSD and PDA, and exclude ASD and PAPVC; then ask: Is there aortic arch enlargement? If yes, then PDA is more likely than VSD Exception is in prematurity, where PDA is more common and may not show arch enlargement

6 Questionable LA enlargement; marked RA enlargement

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9 Coronary arteriovenous fistula
Approximate incidence is 2 in 100,000 RCA and LCA probably about equal Drainage to RV more common than RA; can drain to pulmonary artery All combinations have been seen Can be congenital or acquired -- sometimes associated with other anomalies Sometimes asymptomatic -- presentation with CHF and MI RCA to RA in this case Mavroudis published a series in which nearly all isolated fistulas were asymptomatic -- others have shown that congenital lesions are frequently symptomatic; best guess is that 50% are symptomatic

10 Treatment Early ligation is preferred -- expect persistent dilation of the ligated artery Sometimes do coronary bypass with mammary artery graft Endovascular embolization also extensively documented Unclear which method is more effective -- surgical ligation probably better

11 References Higgins CB. Clinical-radiographic Classification of Congenital Heart Disease. In “Thoracic Imaging: Pulmonary and Cardiovascular Radiology”. LWW; 2006: Wang NK et al. Coronary arteriovenous fistula in pediatric patients: a 17-year institutional experience. Journal of the Formosan Medical Association. 101(3):177-82, 2002 Mar. Chopra V, et al. Isolated congenital coronary arteriovenous fistula. Indian Journal of Pediatrics. 67(9):661-4, 2000 Sep Trejo Gutierrez, J F, et al. Coronary arteriovenous fistula. Study of 14 cases. Archivos del Instituto de Cardiologia de Mexico. 55(2):153-64, 1985 Mar-Apr Mavroudis C, et al. Coronary Artery Fistulas in Infants and Children: A Surgical Review and Discussion of Coil Embolization. Ann Thorac Surg May;63(5): Kamiya H, et al. Surgical treatment of congenital coronary artery fistulas: 27 years' experience and a review of the literature. Journal of Cardiac Surgery. 17(2):173-7, 2002 Mar-Apr


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