Evaluation of efficacy of 64-slice multidetector computed tomography in patients with congenital coronary fistulas

OBJECTIVE: To evaluate the efficacy of 64-slice coronary multidetector computed tomography (MDCT) in the assessment of congenital coronary artery fistula (CCAF). METHODS: Two readers prospectively evaluated the 64-slice coronary MDCT appearances of CCAF in 10 patients (5 men and 5 women; mean age, 58.6 years; range, 19-82 years). Fistula origin, course, distal entry site, and maximal receiving chamber/vessel dimensions were determined using retrospective multisegment reconstructions at 10% increments of the cardiac cycle. RESULTS: Origin, course, and distal vessel entry site of CCAF were clearly outlined in all patients. The distal vessel draining site involved multiple small entry vessels in 5 patients and a single entry vessel in 5 patients. The right atrium in 3 patients and right ventricle in all patients were enlarged. Contrast opacification of the receiving chamber (contrast shunt sign) was detected in 4 patients, indicating patency and site of fistula entry. CONCLUSION: Cardiac 64-slice MDCT provides excellent visualization of the origin, course, and distal vessel entry site of CCAF and the size of the receiving chamber.