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Xie M, Li L, Cheng TO, Sun Z, Wang X, Lv Q, Peng H, Yuan L, Wang J, Zhang L. Coronary artery fistula: comparison of diagnostic accuracy by echocardiography versus coronary arteriography and surgery in 63 patients studied between 2002 and 2012 in a single medical center in China. Int J Cardiol 2014; 176:470-7. [PMID: 25115264 DOI: 10.1016/j.ijcard.2014.07.198] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/27/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Coronary artery fistula (CAF) is a rare congenital anomaly, which is conventionally diagnosed by coronary arteriography; however, the relation of the coronary artery fistulas to other structures, their origin and course may not be always apparent. METHODS The echocardiograms of 63 patients with coronary artery fistulas, who had undergone coronary arteriography and/or surgery from June 2002 to December 2012 at the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were analyzed retrospectively, and the results were compared with findings by coronary arteriography and at surgery. RESULTS Right CAFs were detected in 33 of the 63 patients (52.4%); 11 had drainage to the right atrium, 10 to the right ventricle, 2 to the left ventricle, 9 to the main pulmonary artery, and 1 to the coronary sinus. Left CAFs were detected in 29 patients (46.0%); 6 had drainage to the right atrium, 12 to the right ventricle, 1 to the left atrium, 2 to the left ventricle, 7 to the main pulmonary artery, and 1 to the coronary sinus. One patient (1.6%) had the origin of the fistula in both coronary arteries. The entry point of the fistula was most often a single orifice (96.8%) and rarely multi-orificial (3.2%). 57 patients (90.5%) had isolated coronary fistulas (90.5%); 6 patients (9.5%) had other congenital cardiac malformations. The ultrasonic diagnosis of 60 patients was in line with findings at surgery and/or coronary arteriography. The diagnostic accuracy rate for coronary artery fistula was 95.2%. Preoperative transthoracic echocardiography missed the diagnosis of coronary artery fistula in three patients (4.8%). There is no difference (P>0.05) in diagnostic accuracy between echocardiography and coronary arteriography and/or surgery. CONCLUSIONS Transthoracic echocardiography, in comparison with coronary arteriography and/or surgery, is much simpler, easier, less expensive, safer, readily repeatable, and more convenient with equal accuracy, and should be the first-line method for the diagnosis of congenital coronary artery fistula.
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Affiliation(s)
- Mingxing Xie
- Department of Ultrasonography, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Ling Li
- Department of Ultrasonography, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Tsung O Cheng
- Department of Ultrasonography, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China; Department of Medicine, George Washington University Medical Center, 2150 Pennsylvania Avenue, N.W., Washington, DC 20037, USA.
| | - Zhenxing Sun
- Department of Ultrasonography, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Xinfang Wang
- Department of Ultrasonography, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Qing Lv
- Department of Ultrasonography, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Hua Peng
- Department of Pediatrics, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Li Yuan
- Department of Ultrasonography, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jing Wang
- Department of Ultrasonography, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Li Zhang
- Department of Ultrasonography, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
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Badak O, Akdeniz B, Goldeli O. Five Chambered Heart: A Case Report and Brief Review of Literature. Int J Cardiovasc Imaging 2006; 22:785-9. [PMID: 16786258 DOI: 10.1007/s10554-006-9115-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Accepted: 05/29/2006] [Indexed: 11/24/2022]
Abstract
We present a patient with chest pain and suspicious findings in electrocardiography and myocardial perfusion scintigraphy for myocardial ischemia. Coronary angiography and then echocardiography and magnetic resonance imaging revealed a dilated left anterior descending coronary artery, which has fistulous communication with a large, separate chamber that occupies the infero-apical interventricular septum. This is a challenging congenital anomaly for a clinician in many aspects, which are discussed in the report.
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Affiliation(s)
- Ozer Badak
- Department of Cardiology, School of Medicine, Dokuz Eylul University, 35340, Inciralti, Izmir, Turkey.
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Rickli H, Attenhofer Jost CH, Locher JT, Jenni R. Double-Chambered Left Ventricle: Unusual Presentation with an Apical Defect in a Thallium Scan in a Middle-Aged, Asymptomatic Woman. Echocardiography 1999; 16:387-391. [PMID: 11175166 DOI: 10.1111/j.1540-8175.1999.tb00830.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A left ventricular apical filling defect was found in a whole-body thallium scan performed for routine follow-up for surgically cured thyroid cancer in a 51-year-old woman. She had no cardiovascular symptoms, and her electrocardiogram at rest and during exercise was unremarkable. Transthoracic and transesophageal echocardiography revealed a double-chambered left ventricle. A prominent fibromuscular ridge distal to the papillary muscles was seen dividing the left ventricular cavity into a small apical portion and a large basal portion. There was no significant intraventricular gradient. No treatment was necessary, and the patient has remained asymptomatic in a 4-year follow-up.
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Affiliation(s)
- Hans Rickli
- Echocardiography Laboratory, Division of Cardiology, University Hospital, Raemistr. 100, 8091 Zurich, Switzerland
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