Coronary artery fistulas (CAF) are found in 0.3-1% of patients undergoing coronary angiography and are the most common hemodinamically significant congenital coronary artery anomalies. Even if coronary angiography remains the gold standard for imaging the coronary tree, nevertheless the relationship of CAF to other structures is at times unclear, and the origin and course of CAF can be limited by overlap of adjacent structures. To evaluate the ability of multiplane color Doppler transesophageal echocardiography (TEE) to identify such abnormalities, eighteen patients (pts) with angiographically confirmed CAF were investigated. The study was conducted in four Italian Hospitals on patients observed between January 1997 and February 2001. TEE correctly diagnosed fistolous connection from the left circumflex artery into the coronary sinus near its opening into the right atrium in 2 pts, into the right ventricular outflow tract or main pulmonary artery in 2 pts , and into the left ventricle in 1 pt. A fistula arising from the left anterior descending artery or left main coronary artery was observed in 9 patients, with a drainage to the right ventricle or main pulmonary artery. In 4 pts the origin of the fistula was from the right coronary artery and drainage sites were the lateral aspect of the right ventricle, the low posterior right atrium, and the superior vena cava. A meticulous multiplane TEE examination was helpful in delineating the fistulous connection using standard and nonstandard planes, following as much of the course of the dilated coronary artery and the coronary sinus as possible. In 3 pts angiography did not allow to identify the precise site of fistula into the coronary sinus or the right ventricle. Thus, multiplane color Doppler TEE is useful not only in the diagnosis but also in the precise localization of CAF. The exact site of the fistolous connection may not be delineated by angiography and in this regard multiplane TEE appears to be a valuable supplement to this diagnostic technique.
MULTIPLANE TRANSESOPHAGEAL COLOR DOPPLER ECHOCARDIOGRAPHY IN THE EVALUATION OF CONGENITAL ARTERY FISTULAS / Vitarelli, Antonino; Conde, Y; DE CURTIS, G; DI BENEDETTO, G; Corvo, P; Pecce, P; Chiriac, Y; Colantonio, M; DE NARDO, L; Squillaci, E.. - In: EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY. - ISSN 1525-2167. - STAMPA. - 2(Suppl.):(2001), p. S70. (Intervento presentato al convegno EUROECHO 5 tenutosi a Nice, France nel 5-8 Dec. 2001).
MULTIPLANE TRANSESOPHAGEAL COLOR DOPPLER ECHOCARDIOGRAPHY IN THE EVALUATION OF CONGENITAL ARTERY FISTULAS
VITARELLI, Antonino;
2001
Abstract
Coronary artery fistulas (CAF) are found in 0.3-1% of patients undergoing coronary angiography and are the most common hemodinamically significant congenital coronary artery anomalies. Even if coronary angiography remains the gold standard for imaging the coronary tree, nevertheless the relationship of CAF to other structures is at times unclear, and the origin and course of CAF can be limited by overlap of adjacent structures. To evaluate the ability of multiplane color Doppler transesophageal echocardiography (TEE) to identify such abnormalities, eighteen patients (pts) with angiographically confirmed CAF were investigated. The study was conducted in four Italian Hospitals on patients observed between January 1997 and February 2001. TEE correctly diagnosed fistolous connection from the left circumflex artery into the coronary sinus near its opening into the right atrium in 2 pts, into the right ventricular outflow tract or main pulmonary artery in 2 pts , and into the left ventricle in 1 pt. A fistula arising from the left anterior descending artery or left main coronary artery was observed in 9 patients, with a drainage to the right ventricle or main pulmonary artery. In 4 pts the origin of the fistula was from the right coronary artery and drainage sites were the lateral aspect of the right ventricle, the low posterior right atrium, and the superior vena cava. A meticulous multiplane TEE examination was helpful in delineating the fistulous connection using standard and nonstandard planes, following as much of the course of the dilated coronary artery and the coronary sinus as possible. In 3 pts angiography did not allow to identify the precise site of fistula into the coronary sinus or the right ventricle. Thus, multiplane color Doppler TEE is useful not only in the diagnosis but also in the precise localization of CAF. The exact site of the fistolous connection may not be delineated by angiography and in this regard multiplane TEE appears to be a valuable supplement to this diagnostic technique.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
