National Institute of Cardiology, Warszawa, Poland.
Department of Diagnostic Radiology, The National Institute of Medicine of the Ministry of Interior and Administration, Warszawa, Poland.
Kardiol Pol. 2023;81(12):1217-1226. doi: 10.33963/v.kp.97829. Epub 2023 Nov 24.
Coronary artery fistulas (CAFs) are usually congenital coronary artery anomalies of termination.
This study aimed to assess the prevalence, anatomic characteristics, and clinical significance of CAFs detected by computed tomography (CT) in an adult population.
We performed 45 817 CT examinations in 39 066 subjects between 2008 and 2020. The electronic database was manually checked using specific keywords to identify patients with CAFs. The CT characteristics of CAFs were evaluated. CAF was defined as clinically significant if it was the most plausible cause of myocardial infarction, infective endocarditis, heart failure, death during follow-up, hospitalization, or if it required either percutaneous or surgical intervention.
Of 39 066 patients, 56 CAFs were detected in 42 subjects (20 men, 47.6%) with a prevalence of 0.11%. Most CAFs originated from the right coronary artery (RCA) (48.2%) and drained into the pulmonary artery (PA) (58.9%). CAFs terminating in the PA were more frequently multiple (P <0.001) and tortuous (P <0.001) as compared to CAFs without PA drainage. Clinically significant CAFs, identified in 7 of 42 patients, were more common in younger (P = 0.03) and male (P = 0.04) subjects and had larger lumen area and diameter at the site of origin (P = 0.03, P = 0.03, respectively).
In the unselected adult population undergoing coronary CT angiography, the RCA and the PA are the most common sites of origin and termination of CAFs, respectively. CAFs draining into the PA are more often multiple and tortuous. Clinically meaningful CAFs are larger and most frequently detected in younger and male patients.
冠状动脉瘘（CAF）通常是冠状动脉的先天性终末异常。
本研究旨在评估计算机断层扫描（CT）在成年人群中检测到的 CAF 的流行率、解剖特征和临床意义。
我们在 2008 年至 2020 年间对 39066 例患者进行了 45817 次 CT 检查。使用特定关键字手动检查电子数据库，以识别出存在 CAF 的患者。评估了 CAF 的 CT 特征。如果 CAF 是心肌梗死、感染性心内膜炎、心力衰竭、随访期间死亡、住院或需要经皮或手术干预的最可能原因，则将其定义为具有临床意义。
在 39066 例患者中，在 42 例患者（20 名男性，占 47.6%）中发现了 56 个 CAF，患病率为 0.11%。大多数 CAF 起源于右冠状动脉（RCA）（48.2%），并引流至肺动脉（PA）（58.9%）。与无 PA 引流的 CAF 相比，引流至 PA 的 CAF 更常为多发性（P <0.001）和迂曲性（P <0.001）。在 42 例患者中确定的 7 例具有临床意义的 CAF 更常见于年轻（P = 0.03）和男性（P = 0.04）患者，并且起源部位的管腔面积和直径更大（P = 0.03，P = 0.03）。
在接受冠状动脉 CT 血管造影的未选择成年人群中，RCA 和 PA 分别是 CAF 最常见的起源和终末部位。引流至 PA 的 CAF 更常为多发性和迂曲性。具有临床意义的 CAF 更大，并且最常发生于年轻和男性患者。
