coronary arteriovenous fistula ali sepahdari, md 4/6/07
TRANSCRIPT
Coronary Arteriovenous Fistula
Ali Sepahdari, MD
4/6/07
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
Further subdivision…
VSD, ASD, PDA, PAPVC, other
TGA, truncus, TAPVC, TA, single vent, DORV, DOLV, HLH, multiple pulm AVM’s
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
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
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
References Higgins CB. Clinical-radiographic Classification of Congenital Heart Disease. In
“Thoracic Imaging: Pulmonary and Cardiovascular Radiology”. LWW; 2006: 679-706
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. 1997 May;63(5):1235-42.
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