Coronary artery fistulas in children. Evaluation with 64-slice multidetector CT

There are various types of coronary artery fistulas (CAF) with complex shapes. Therefore, it is important to make a correct diagnosis and to understand the relationship of the CAF to the adjacent structures before transcatheter occlusion or surgery. This study evaluated the feasibility of using 64-slice multidetector computed tomography (MDCT) angiography in diagnosing CAF. Two readers who were blinded to the results of echocardiography, intervention, or surgery retrospectively evaluated the coronary MDCT appearances of CAF in 10 patients (4 boys and 6 girls; mean age, 2.9 years; range, 1-6 years). The origin, course, and distal entry site of the fistula were determined. The diameters of the origin and the distal entry site were measured and compared with those seen during intervention or surgery. The origin, course, and distal vessel entry site of the CAF were clearly outlined in all patients by MDCT. The distal vessel draining site involved a single entry vessel in all patients. Seven fistulas involved the right coronary artery, and three involved the left coronary artery. Four fistulas drained into the right ventricle, four into the right atrium, and two into the left ventricle. The diagnosis of CAF using MDCT was in accordance with diagnoses made during intervention or surgery. There was an excellent correlation between MDCT and transcatheter occlusion in quantifying the diameters of the origin and distal entry site (R = 0.90 and 0.92, respectively, P < 0.05). Coronary 64-slice MDCT angiography depicted the whole shape and course of the CAF as well as of the surrounding structures. It may serve as a noninvasive diagnostic tool when planning a therapeutic strategy.