Coronary Arteriovenous Fistula Ali Sepahdari, MD 4/6/07.
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Transcript of Coronary Arteriovenous Fistula Ali Sepahdari, MD 4/6/07.
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Coronary Arteriovenous Fistula
Ali Sepahdari, MD
4/6/07
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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
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Further subdivision…
VSD, ASD, PDA, PAPVC, other
TGA, truncus, TAPVC, TA, single vent, DORV, DOLV, HLH, multiple pulm AVM’s
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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
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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
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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
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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