Clinical manifestation of coronary pulmonary arterial fistula diagnosed by cardiac computed tomography

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background  Coronary pulmonary arterial fistula (CPAF) may cause enlargement of an aneurysm, which may rupture or compress other organs, or occurrence of steal phenomenon of coronary arterial (CA) blood flow. We hypothesize that there are various clinical characteristics of CPAF including patient age at diagnosis, method of diagnosis, observed symptoms, complications, and surgical interventions Methods  From a total of >17,000 patients undergoing CT from 2000-2019 in our institute, 11 patients diagnosed as having CPAF were analyzed retrospectively. One was treated surgically prior to analysis, and the remaining 10 (3 males; 56 ± 12 years) were followed for a mean of 52 ± 64 months. Results  5 were diagnosed as having CPAF through cardiac CT and 2 were diagnosed by invasive coronary angiograms. One was diagnosed by TTE and another patient was diagnosed by TTE and cardiac CT to differentiate from a mediastinal tumor. 4 had dyspnea, 2 had chest pain, and 1 had palpitation. 5 showed other cardiovascular disease (1 with left ventricular non-compaction, and persistent left superior vena cava; 1 with vascular type Ehlers-Danlos syndrome; 1 with hypertrophic cardiomyopathy; 1 with aortic valve regurgitation (AR); and 1 with vasospastic angina pectoris). The occurrence of steal phenomenon of CA blood flow was diagnosed in 4. CA aneurysm was observed in 5. 2 had abnormal flow from descending aorta to pulmonary arteries through CA. Pulmonary arterial systolic pressure >30 mmHg was observed in 2. During the observed periods, 4 underwent surgical procedure to eliminate CA aneurysm (N = 2), or for significant steal phenomenon of CA blood flow (N = 1). A patient with AR underwent CPAF elimination simultaneously with aortic valve replacement. The mean periods between initial diagnoses and surgical intervention was 27 ± 36 months. The remaining 6 were followed without surgical intervention for a mean of 69 ± 76 months without any cardiac events. Conclusion  CPAF was diagnosed at a mean age of 56 years and half were diagnosed incidentally by cardiac CT. Five of the 11 patients (45%) underwent a surgical procedure. Patients with CPAF showed various symptoms due to complicating diseases, anatomical configurations, and outcomes. Abstract Figure. Typical CT images of CPAF