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

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Abstract

AIM

To assess the functionality of congenital coronary artery fistulas (CAFs) using adenosine stress ¹³N-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 ¹³N-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 ¹³N-ammonia PET-CT revealed normal myocardial perfusion and ejection fraction in all but one patient, who showed a reduced ejection fraction.

CONCLUSION

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.

Related collections

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Author and article information

Contributors

Salah AM Said

Aly Agool

Arno HM Moons

Mounir WZ Basalus

Nils RL Wagenaar

Rogier LG Nijhuis

Jutta M Schroeder-Tanka

Riemer HJA Slart

Journal

Journal ID (nlm-ta): World J Cardiol

Journal ID (publisher-id): WJC

Title: World Journal of Cardiology

Publisher: Baishideng Publishing Group Inc

ISSN (Electronic): 1949-8462

Publication date (Print): 26 October 2018

Publication date (Electronic): 26 October 2018

Volume: 10

Issue: 10

Pages: 153-164

Affiliations

Department of Cardiology, Hospital Group Twente, Almelo-Hengelo 7555 DL, Overijssel, The Netherlands. samsaid@ 123456home.nl

Department of Nuclear Medicine, Hospital Group Twente, Almelo-Hengelo 7555 DL, Overijssel, The Netherlands

Department of Cardiology, Slotervaart Hospital, Amsterdam 1066 EC, North Holland, The Netherlands

Department of Cardiology, Hospital Group Twente, Almelo-Hengelo 7555 DL, Overijssel, The Netherlands

Department of Nuclear Medicine, Hospital Group Twente, Almelo-Hengelo 7555 DL, Overijssel, The Netherlands

Department of Cardiology, Hospital Group Twente, Almelo-Hengelo 7555 DL, Overijssel, The Netherlands

Department of Cardiology, Hospital Onze Lieve Vrouwe Gasthuis, Location West, Amsterdam 1061 AE, North Holland, The Netherlands

Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands

Faculty of Science and Technology, Biomedical Photonic Imaging, University of Twente, Enschede 7522 NB, The Netherlands

Author notes

Author contributions: All authors contributed to this paper; concept and design by Said SAM and Basalus MWZ; data acquisition by Moons AHM, Schroeder-Tanka JM and Nijhuis RLG; analysis of nuclear studies Agool A, Wagenaar NRL and Slart RHJA; Slart RHJA performed critical revision of manuscript; all authors have approved the final version of the paper.

Correspondence to: Salah AM Said, MD, PhD, Doctor, Staff Physician, Cardiologist, Department of Cardiology, Hospital Group Twente, Geerdinksweg 141, Almelo-Hengelo 7555 DL, Overijssel, The Netherlands. samsaid@ 123456home.nl

Telephone: +31-88-7085286 Fax: +31-88-7085289

Article

Other ID: jWJC.v10.i10.pg153

DOI: 10.4330/wjc.v10.i10.153

PMC ID: 6205851

PubMed ID: 30386493

SO-VID: 445cf85a-123c-4e4d-9a59-4f5654938f48

License:

This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

History

Date received : 27 June 2018

Date revision received : 21 August 2018

Date accepted : 30 August 2018