An analysis of the computed tomography angiography features of coronary-pulmonary fistula

Abstract:

Objective：To analyze the anatomical information of coronary-pulmonary fistula（CPF） based on the examination data from coronary computed tomography angiography（CCTA）. Methods：A retrospective analysis was conducted on the CCTA data of 71 patients with CPF. Analyses and calculations were performed on the fistula feeding arteries，location and size of the fistula orifice and its relationship with surrounding anatomical structures，type of inflow to the fistula，and diameters of the aorta and the pulmonary artery with the 95% confidence intervals[CIs] evaluated for the fistula orifice size，diameter of its feeding arteries，and distance between the fistula orifice and the pulmonary valve. Statistical analyses were made on the differences in diameters of feeding arteries and the correlation of the width of the fistula orifice with the diameters of the aorta，the pulmonary artery，and the dominant feeding arteries. In addition，statistical analyses were made on the differences between cases with different types of inflow to the fistula in terms of the fistula orifice size and the diameter of feeding arteries. Results：Ninety-eight point five percent（70/71） of the cases had a fistula in the pulmonary trunk in the direction of 12 o’clock to 3 o’clock，60.6%（43/71） had bilateral blood supply，9.9%（7/71） had a blood supply from the right coronary artery，29.6%（21/71） had a blood supply from the left coronary artery，42.3%（30/71） showed a “puff of smoke” sign，and 46.5%（33/71） showed an “ejecting” sign. After excluding the isolated case with a fistula in the left pulmonary trunk，mean values of fistula size，distance between the fistula orifice and the pulmonary valve，and diameter of feeding arteries were （2.5±1.1），（3.1±2.0），and （15.1±6.7） mm，respectively，with the corresponding 95%CI as 2.6～3.6，13.8～15.5，and 2.2～2.8 mm，respectively. The location of feeding arteries from the right coronary artery was significantly closer to the fistula com－pared with that from the left coronary artery（t=11.03，P<0.05），but there was no significant difference in the diameter of feeding arteries from both sides（P>0.05）. The fistula orifice size was positively correlated with the diameter of the aorta and the feeding arteries（r=0.505，P<0.05），but not correlated with the diameter of the pulmonary artery. There were no significant differences between cases with different types of inflow to the fistula in terms of fistula orifice size or the diameter of feeding arteries（P>0.05）. Conclusion：CCTA can visualize the anatomical characteristics of CPF and measure relevant anatomical structures，thus providing useful information for clinical evaluation and therapeutic method selection for CPF.