Bronchial to coronary artery fistulas: an important sign of silent coronary artery disease and potential complication during bronchial artery embolization

Coronary artery fistulas are rare and usually asymptomatic congenital anomalies generally diagnosed incidentally during coronary angiographies. Herein, we present a case of bronchial to coronary artery fistula which was diagnosed incidentally during bronchial artery embolization. Embolization was performed successfully without complication, and an underlying important coronary artery stenosis was subsequently found by coronary computed tomography angiography.     

Findings of bilateral coronary to pulmonary artery fistula in 64-multislice computed tomographic angiography: correlation with catheter angiography

A 63-year-old man, who underwent conventional coronary angiography, because of a finding of a confusing vascular structure, was referred for 64-multislice spiral computed tomography (MSCT). His MSCT showed bilateral coronary-pulmonary artery fistula from both right and left coronary arteries via a dilated fistulous vascular malformation. Considering its reasonably high spatial and temporal resolutions, MSCT is regarded as a valuable technique to clarify the diagnosis in incidentally found equivocal cases of coronary fistula in conventional coronary angiography.     

Giant coronary artery bypass graft pseudoaneurysm presenting as a haemothorax

Coronary artery bypass graft pseudoaneurysms are rare. A case of a giant coronary artery pseudoaneurysm with probable intrapleural leakage and resulting haemothorax 14 years after coronary artery bypass surgery (CABG) is presented. The computed tomography (CT) and angiographic appearances are described. To our knowledge, this clinical presentation of a CABG pseudoaneurysm has not been described. Walsh, G. (2001). Clinical Radiology56, 74-75.     

Noninvasive evaluation of a fistula between a giant coronary aneurysm and coronary sinus performed via multidetector row computed tomography

Coronary artery fistula (CAF) is an uncommon anomaly of congenital and rarely iatrogenic etiology. Most of the patients are asymptomatic, and the anomaly is incidentally recognized during a coronary angiography performed for other reasons. Also, coronary artery aneurysms are rare. We report a case of CAF associated with a giant aneurysm evaluated using multidetector row computed tomography.     

冠状动脉瘘的双源CT诊断

目的:探讨双源CT(DSCT)冠状动脉成像对冠状动脉瘘的诊断价值.方法:对1000例患者行DSCT冠状动脉增强扫描,分析其断层图像,结合最大密度投影(MIP)、曲面重组(CPR)、多平面重组(MPR)和容积再现(VR)等方法观察冠状动脉的走行及心内外机构.结果:11例患者有冠状动脉瘘,其中右冠状动脉主干-肺动脉瘘5例,...     

Single coronary artery with spasm

A single coronary artery is a rare and potentially serious anomaly. We present the case of a 54-year-old woman with chest pain predominantly at rest. A single coronary artery was demonstrated by 64-row multidetector computed tomography (CT) imaging, which is useful for the diagnosis and classification of coronary anomaly. In our case, no coronary artery stenosis was demonstrated on CT angiographic images, and totally occlusive coronary spasm was confirmed by intracoronary infusion of acetylcholine.     

Physiologic assessment of coronary artery fistula

Coronary artery fistula is an uncommon clinical entity. The most common coronary artery fistula is from the right coronary artery to the right side of the heart, and it is less frequent to the pulmonary artery. The effect of a coronary artery fistula may be physiologically significant because of the steal phenomenon resulting in coronary ischemia. Based on published reports, it is recommended that patients with congenital coronary artery fistulas be considered candidates for elective surgical correction to prevent complications including development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and coronary aneurysm formation with rupture or embolization. A patient is presented in whom treadmill-exercise thallium imaging was effective in determining the degree of coronary steal from a coronary artery fistula, leading to successful corrective surgery.     

Applications of multislice computed tomography in coronary artery disease

Multislice computed tomography (MSCT) provides high accuracy for noninvasive assessment of coronary artery disease (CAD). The introduction of the latest computed tomography (CT) technology allows comprehensive evaluation of various aspects of CAD, including the coronary calcium score, coronary artery stenoses, bypass patency, and myocardial function. Other applications, such as plaque characterization, first-pass perfusion imaging, and viability imaging using delayed contrast enhancement, are still under development and may demonstrate clinical utility in the future. Further improvements in CT hardware and imaging protocols are expected that may result in improved coronary artery imaging, new applications, and a significant reduction of radiation dose.     

64层螺旋CT诊断成人冠状动脉起源异常

目的 探讨64层螺旋CT诊断成人冠状动脉起源异常的价值。方法 对978例成人冠状动脉CT血管成像（CTA）资料进行回顾性分析、总结，并与国内外文献比较。结果 978例完整冠状动脉CTA结果中，共检出成人冠状动脉起源异常30例，检出率为3．07％，包括右冠状动脉起源异常9例（30．00％），左冠状动脉起源异常7例（23.33％），左、右冠状动脉均起源异常2例（6.67％），回旋支缺如1例（3.33％）和冠状动脉其他分支起源异常11例（36．67％）。结论 64层螺旋CT诊断成人冠状动脉起源异常是一种无创、安全和有效的方法。     

Evaluation of unroofing procedure of anomalous origin of right coronary artery from left sinus of valsalva between aorta and pulmonary trunk by multidetector computed tomography

An anomalous origin of a coronary artery is a rare congenital anomaly. Conventionally, the diagnosis of coronary artery anomalies is performed by coronary angiography. Currently developed multidetector computed tomography has permitted better definition of the coronary arteries, however. Multidetector computed tomography could be used effectively in the diagnosis and evaluation of the postoperative status of a patient with an anomalous origin of the right coronary artery from the left sinus of Valsalva between the aorta and pulmonary trunk.     

T1-weighted MRI for the detection of coronary artery plaque haemorrhage

Objective  

Hyperintense areas in atherosclerotic plaques on pre-contrast T1-weighted MRI have been shown to correlate with intraplaque haemorrhage. We evaluated the presence of T1 hyperintensity in coronary artery plaques in coronary artery disease (CAD) patients and correlated results with multi-detector computed tomography (MDCT) findings.     

Lack of correlation between coronary artery calcium and myocardial perfusion imaging

BACKGROUND: Coronary artery calcium (CAC) provides evidence of coronary atherosclerosis and has significant prognostic power. Although prior studies have documented a relationship between CAC and hemodynamically significant coronary artery stenosis, the results have not been conclusive. METHODS AND RESULTS: We evaluated 126 consecutive patients who underwent electron beam computed tomography CAC scoring by use of the Agatston method and stress myocardial perfusion imaging (MPI) within 3 months of each other. The analysis revealed no correlation between absolute CAC score and age- and gender-adjusted CAC scores with MPI. Overall, 18% of patients had abnormal MPI results irrespective of their CAC. CONCLUSION: CAC scoring and stress MPI should be thus considered complementary approaches rather than exclusionary in the evaluation of the patient at risk for coronary artery disease.     

Myocardial perfusion imaging evidence of functionally complete revascularization by minimally invasive direct coronary artery bypass in 2-vessel coronary artery disease

Background Whether patency of a second diseased vessel still impacts myocardial perfusion when complete revascularization of the left anterior descending coronary artery (LAD) territory has been achieved is currently undetermined. In patients with 2-vessel coronary artery disease and complex LAD lesions, we evaluated the impact of single LAD or integrated revascularization on single photon emission computed tomography-assessed reversible myocardial ischemia. Methods and Results Thirty-five candidates for revascularization with double-vessel disease including the LAD and a preoperative stress single photon emission computed tomography study were studied. Revascularization was performed by minimally invasive direct coronary artery bypass (MIDCAB) alone (n=15) or by an integrated procedure with second-vessel angioplasty, either soon after surgery (n=13) or at 2 months (n=7), according to the extent of reversible perfusion defects in the second vessel territory. At 1 year, the total ischemic area decreased from 9.3±5.1 to 0.8±1.5 in MIDCAB-only patients and from 8.2±4.9 to 1.6±2.9 in the integrated group (P=.87 for treatment and P<.001 for time). The ischemic area in the second vessel territory similarly decreased in both groups (P=.81 for treatment and P<.001 for time). Conclusions In 2-vessel coronary artery disease involving the LAD, MIDCAB alone achieves, in a substantial proportion of patients, functionally complete revascularization even in the nonrevascularized second vessel territory. The study was supported by grant ICS030.6 RF99/15 from the Italian National Ministry of Health.     

Usefulness of coronary postmortem computed tomography angiography to detect lesions in the coronary artery and myocardium in cases of sudden death

Coronary postmortem computed tomography angiography (coronary PMCTA) has been introduced as a routine examination procedure for autopsy at our department. Here, we reviewed eight autopsy cases in which apparent histopathological changes including acute myocardial infarction (AMI), anomalous aortic origin of a coronary artery (AAOCA), hypertrophic obstructive cardiomyopathy (HOCM) and acute myocarditis were involved in the cause of death. For investigation of the coronary artery and shape of the heart, coronary PMCTA was valuable in detecting narrowing or obstruction of coronary artery in AMI, indicating an anomalous aortic origin of the left coronary artery in AAOCA, and demonstrating septal hypertrophy and intracavitary obstruction in HOCM. However, it was debatable whether the hypervascularity demonstrated by coronary PMCTA in the case of acute myocarditis was more prominent than the vascular images obtained in other cases without inflammation. Thus, coronary PMCTA appeared to be useful not only for detection of coronary artery stenosis, but also for indicating other distinctive changes involved in AAOCA and HOCM.     

Erectile dysfunction as a coronary artery disease risk equivalent

Background. The conditions that predispose patients to erectile dysfunction are substantially similar to the coronary artery disease risk factors, including diabetes mellitus, hypertension, hyperlipidemia, obesity, sedentary lifestyle, depression, age, and smoking. Because of these shared risks and overlapping pathophysiologic mechanisms, we designed this pilot study to address the hypothesis that the presence of coronary artery calcium, a known indicator of increased cardiac risk, is associated with erectile dysfunction. Methods and Results. A prospective registry enrolled 9150 men who underwent multidetector computed tomography. Subjects supplied baseline data regarding demographic variables, coronary risk factors, and erectile dysfunction symptoms or lack thereof. The 2 groups then underwent computed tomography to screen for the presence or absence of coronary artery calcium. Subjects with erectile dysfunction were older, had higher triglyceride levels, had higher blood pressures, and were more likely to have measurable coronary artery calcification than men without erectile dysfunction (79% vs 58%,P<.001). Conclusion. Erectile dysfunction is significantly associated with abnormal coronary artery calcification and, like peripheral arterial disease, might warrant consideration as a coronary artery disease risk equivalent.     

Diagnostic value of MDCT angiography in assessment of coronary artery bypass graft

Purpose

To evaluate the diagnostic value of MDCT angiography in assessment of coronary bypass grafts. We studied 51 patients from April 2008 to October 2011. All patients gave written informed consent, and the study protocol was approved by the Institutional Review Board. 96 grafts including 35 left internal mammary artery (LIMA) grafts, 5 radial artery grafts, and 56 saphenous vein grafts (SVG) were assessed by 64-MDCT and the results were compared with conventional coronary angiography as reference standard.

Results

The diagnostic value of multi-detector computed tomography for graft occlusion was: 100% sensitivity, 100% specificity, 100% positive predictive value, and 100% negative predictive value. The diagnostic power of multi-detector computed tomography for stenosis of the graft anastomosis was: 100% sensitivity, 96% specificity, 87.5% positive predictive value, and 100% negative predictive value, and 96.4% accuracy.

Conclusion

Multi-detector computed tomography has become an alternative to coronary angiography to diagnose graft occlusion and stenosis after coronary artery bypass. In addition, multidetector CT has the added advantage over traditional angiographic evaluation of simultaneously allowing evaluation for alternate postoperative complications that may also manifest with chest pain and dyspnea, thereby mimicking recurrent angina.     

先天性心脏病冠状动脉瘘的介入治疗

目的：评价经皮穿刺栓塞术治疗冠状动脉瘘的疗效。材料与方法：１９９５年６月至１９９６年８月，对４名冠状动脉瘘患儿实施了经皮穿刺冠状动脉瘘栓塞术，采用８ｍｍ、１０ｍｍ、１２ｍｍ及１５ｍｍ直径（Ｃｏｏｋ公司产品）弹簧栓子，手术前、后进行左、右心导管检查及冠状动脉造影，以进一步诊断和评价治疗效果。结果：４例操作技术全部成功，通过手术前后心导管检查及选择性冠状动脉造影，证明栓塞效果可靠，术后心电图无异常，其中３例随诊半年，１例随诊２个月，效果良好。结论：经皮穿刺栓塞术是治疗冠状动脉瘘的有效方法。     

Noninvasive coronary angiography using 64-detector-row computed tomography in patients with a low to moderate pretest probability of significant coronary artery disease

PURPOSE: To evaluate the value of 64-detector-row computed tomography for ruling out high-grade coronary stenoses in patients with a low to moderate pretest probability of significant coronary artery disease. MATERIAL AND METHODS: The study included 61 patients with a suspicion of coronary artery disease on the basis of atypical angina or ambiguous findings in noninvasive stress testing and a class II indication for invasive coronary angiography (ICA). All patients were examined by 64-detector-row computed tomography angiography (CTA) and ICA. On a coronary segmental level, the presence of significant (> or = 50% diameter) stenoses was examined. RESULTS: In a total of 915 segments, CTA detected 62 significant stenoses. Thirty-four significant stenoses were confirmed by ICA, whereas 28 stenoses could not be confirmed by ICA. Twenty-two of them showed wall irregularities on ICA, and six were angiographically normal. Accordingly, on a coronary segmental basis, 28 false-positive and 0 false-negative findings resulted in a sensitivity of 100%, a specificity of 96.8%, a positive predictive value of 54.8%, and a negative predictive value of 100%. The diagnostic accuracy was 96.9%. CONCLUSION: Sixty-four-detector-row computed tomography reliably detects significant coronary stenoses in patients with suspected coronary artery disease and appears to be helpful in the selection of patients who need to undergo ICA. Calcified and non-calcified plaques are detected. Grading of stenoses in areas with calcification is difficult. Frequently, stenosis severity is overestimated by 64-detector-row computed tomography.     

先天性冠状动脉瘘心血管造影诊断及治疗

目的 介绍先天性冠状动脉瘘的心血管造影特点及其治疗方法。方法 35例均采用肝锁位、长轴斜位、右前斜位、后前位及侧位分别进行左心室、升主动脉和选择性冠状动脉造影。结果 35例冠状动脉瘘显示清晰,其中20例手术治疗成功,9例行弹簧钢圈堵塞术,8例成功。结论 先天性冠状动脉瘘是一种少见的畸形,一旦明确诊断,应及早治疗。目前除手术外,导管介入治疗不失为有效的方法。