Coronary-to-Pulmonary Artery Fistula in Adults: Natural History and Management Strategies
- Author:
Hokun KIM
1
;
Kyongmin Sarah BECK
;
Yeon Hyeon CHOE
;
Jung Im JUNG
Author Information
- Publication Type:Multicenter Study
- Keywords: CT angiography; Coronary artery; Pulmonary artery; Vascular fistula; Prognosis; Coronary artery anomaly
- MeSH: Adult; Aneurysm; Angiography; Arteries; Coronary Artery Disease; Coronary Vessels; Diagnosis; Fistula; Follow-Up Studies; Humans; Methods; Natural History; Prognosis; Pulmonary Artery; Retrospective Studies; Vascular Fistula
- From:Korean Journal of Radiology 2019;20(11):1491-1497
- CountryRepublic of Korea
- Language:English
- Abstract: OBJECTIVE: To evaluate the natural course of coronary-to-pulmonary artery fistula (CPAF) detected on coronary computed tomography angiography (CCTA) and to propose potential treatment strategies. MATERIALS AND METHODS: In this retrospective multicenter study, we assessed the CCTA reports of 188 CPAF patients evaluated between March 2009 and June 2016. Fifty-seven patients were excluded because their follow-up (FU) periods were less than 2 years. Information regarding demographic characteristics, past history, treatment method, and the occurrence of major adverse cardiac events (MACE) during the FU period was collected. We analyzed the morphologic features of CPAF and the various factors associated with surgical treatment. Patients who had undergone FU CCTA after being diagnosed with CPAF were assessed for the presence of morphological changes on FU imaging. RESULTS: The median age of the study population was 63.0 years (range, 57.0–72.0 years), and the median FU period was 5.72 years (range, 4.08–6.96 years). The most common origin of the CPAF was both coronary arteries in 76 (58.0%) cases. An aneurysm or aneurysms was/were present in 41 (31.3%) cases. Fifty-four (41.2%) fistulas were less than 2 mm in size. Eight patients underwent surgery, and 123 (93.9%) patients received optimal medical treatment (OMT). The fistula size was significantly different between the two treatment groups (p = 0.013) and was the only factor associated with surgical treatment (odds ratio = 1.14, p = 0.021). Only one patient in the OMT group reported MACE during the FU period due to preexisting coronary artery disease. Twenty-nine patients (22.1%) underwent FU CCTA after CPAF diagnosis, with a median FU period of 3.81 years. None of the patients in the OMT group demonstrated morphological changes in the CPAF on FU imaging. CONCLUSION: Most CPAFs identified on CCTA have a favorable prognosis. Observation with OMT is usually an appropriate strategy. Fistula size is a possible determinant for surgical treatment.
