Shiraishi Jun, Takahashi Akiyuki, Kimura Masayoshi, Miyagawa Kotaro, Torii Sayuki, Takeda Mitsuo, Arihara Masayasu, Hyogo Masayuki, Shima Takatomo, Okada Takashi, Watanabe Taiji, Sakai Osamu, Nakajima Masamichi, Kohno Yoshio, Matsubara Hiroaki
Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan.
Department of Cardiovascular Surgery, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan.
J Cardiol Cases. 2009 Nov 11;1(2):e106-e111. doi: 10.1016/j.jccase.2009.10.002. eCollection 2010 Apr.
Coronary angiography (CAG) has been the mainstay of diagnostic image analysis for coronary artery fistula (CAF). However, it is difficult to fully delineate this complex vessel structure including coronary trees, particularly in cases with large CAF, by this method.
In the present 3 cases with large CAF, contrast-enhanced multidetector computed tomography (MDCT) was performed to examine the whole coronary vessel structure including CAF. Selective CAG was also undertaken. In all 3 cases, based on the echocardiographic findings and the characteristic heart murmur, presence of CAF was suspected. However, transthoracic echocardiography as well as CAG alone could not define the whole abnormal vessel structure precisely. Moreover, CAG could not obtain clear images of the coronary artery with large CAF, because of contrast-steal. In contrast, MDCT could not only define CAF in detail but also depict coronary artery adjacent to CAF. On the basis of the MDCT findings, in cases 1 and 3, surgical exclusions were undertaken without and with coronary artery bypass grafting, respectively.
Contrast-enhanced MDCT might be useful for the diagnosis of large CAF and for the estimation of the coronary artery adjacent to CAF, which is absolutely indispensable for surgical treatment.
冠状动脉造影（CAG）一直是冠状动脉瘘（CAF）诊断性影像分析的主要手段。然而，通过这种方法很难完整描绘包括冠状动脉树在内的这种复杂血管结构，尤其是在大型CAF病例中。
在目前这3例大型CAF病例中，进行了对比增强多层螺旋计算机断层扫描（MDCT）以检查包括CAF在内的整个冠状动脉血管结构。同时也进行了选择性CAG。在所有3例病例中，根据超声心动图检查结果和特征性心脏杂音，怀疑存在CAF。然而，单独的经胸超声心动图以及CAG均无法精确界定整个异常血管结构。此外，由于造影剂盗血现象，CAG无法获得大型CAF冠状动脉的清晰图像。相比之下，MDCT不仅可以详细界定CAF，还能描绘与CAF相邻的冠状动脉。基于MDCT检查结果，在病例1和病例3中，分别进行了无冠状动脉旁路移植术和有冠状动脉旁路移植术的手术排除。
对比增强MDCT可能有助于大型CAF的诊断以及评估与CAF相邻的冠状动脉，而这对于手术治疗绝对不可或缺。
