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Incidental congenital coronary artery vascular fistulas in adults:Evaluation with adenosine-13N-ammonia PET-CT

World Journal of Cardiology 2018年第10期10卷 153-164页

作者： Salah AM Said Aly Agool Arno HM Moons Mounir WZ Basalus Nils RL Wagenaar Rogier LG Nijhuis Jutta M Schroeder-Tanka Riemer HJA Slart Department of Cardiology Hospital Group TwenteAlmelo-Hengelo 7555 DLOverijsselThe Netherlands Department of Nuclear Medicine Hospital Group TwenteAlmelo-Hengelo 7555 DLOverijsselThe Netherlands Department of Cardiology Slotervaart HospitalAmsterdam 1066 ECNorth HollandThe Netherlands Department of Cardiology Hospital Onze Lieve Vrouwe GasthuisLocation WestAmsterdam 1061 AENorth HollandThe Netherlands Department of Nuclear Medicine and Molecular Imaging University Medical Center GroningenGroningen 9713 GZThe Netherlands Faculty of Science and Technology Biomedical Photonic ImagingUniversity of TwenteEnschede 7522 NBThe Netherlands

AIM To assess the functionality of congenital coronary artery fistulas(CAFs) using adenosine stress ^(13)N-ammonia positron emission tomography computed tomography(PET-CT).METHODS Congenital CAFs were incidentally detected during coronary angiography(CAG) procedures in 11 adult patients(six males and five females) with a mean age of 64.3 years(range 41-81). Patients were collected from three institutes in the Netherlands. The characteristics of the fistulas(origin, pathway and termination), multiplicity of the origins and pathways of the fistulous vessels were assessed by CAG. Five patients underwent adenosine pharmacologic stress ^(13)N-ammonia PET-CT to assess myocardial perfusion and the functional behavior of the fistula. RESULTS Eleven patients with 12 CAFs, 10 unilateral and one bilateral, originating from the left anterior descending coronary artery(n = 8), right coronary artery(n = 2) and circumflex(n = 2). All fistulas were of the vascular type, terminating into either the pulmonary artery(n = 11) or coronary sinus(n = 1). The CAG delineated the characteristics of the fistula(origin, pathway and termination). Multiplicity of the origins and pathways of the fistulous vessels were common in most fistulas(8/12, 67% and 9/12, 75%, respectively). Multiplicity was common among the different fistula components(23/36, 64%). Adenosine pharmacologic stress ^(13)N-ammonia PET-CT revealed normal myocardial perfusion and ejection fraction in all but one patient, who showed a reduced ejection *** PET-CT may be helpful for assessing the functional status of congenital CAFs in selected patients regarding clinical decision-making. Studies with a larger patient series are warranted.

关键词： coronary angiography coronary-pulmonary artery fistulas Adenosine ammonia positron emission tomography computed tomography coronary vascular fistulas Congenital coronary artery fistulas

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