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Coronary Arteriovenous Fistula

Coronary Arteriovenous Fistula. Ali Sepahdari, MD 4/6/07. Fundamental CXR approach. Further subdivision…. VSD, ASD, PDA, PAPVC, other TGA, truncus, TAPVC, TA, single vent, DORV, DOLV, HLH, multiple pulm AVM’s. Noncyanotic disease. Is there left atrial enlargement?

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Coronary Arteriovenous Fistula

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  1. Coronary Arteriovenous Fistula Ali Sepahdari, MD 4/6/07

  2. Fundamental CXR approach

  3. Further subdivision… VSD, ASD, PDA, PAPVC, other TGA, truncus, TAPVC, TA, single vent, DORV, DOLV, HLH, multiple pulm AVM’s

  4. Noncyanotic disease • Is there left atrial enlargement? • If yes, then consider VSD and PDA, and exclude ASD and PAPVC; then ask: • Is there aortic arch enlargement? • If yes, then PDA is more likely than VSD • Exception is in prematurity, where PDA is more common and may not show arch enlargement

  5. Coronary arteriovenous fistula • Approximate incidence is 2 in 100,000 • RCA and LCA probably about equal • Drainage to RV more common than RA; can drain to pulmonary artery • All combinations have been seen • Can be congenital or acquired -- sometimes associated with other anomalies • Sometimes asymptomatic -- presentation with CHF and MI

  6. Treatment • Early ligation is preferred -- expect persistent dilation of the ligated artery • Sometimes do coronary bypass with mammary artery graft • Endovascular embolization also extensively documented • Unclear which method is more effective -- surgical ligation probably better

  7. References • Higgins CB. Clinical-radiographic Classification of Congenital Heart Disease. In “Thoracic Imaging: Pulmonary and Cardiovascular Radiology”. LWW; 2006: 679-706 • Wang NK et al. Coronary arteriovenous fistula in pediatric patients: a 17-year institutional experience. Journal of the Formosan Medical Association. 101(3):177-82, 2002 Mar. • Chopra V, et al. Isolated congenital coronary arteriovenous fistula. Indian Journal of Pediatrics. 67(9):661-4, 2000 Sep • Trejo Gutierrez, J F, et al. Coronary arteriovenous fistula. Study of 14 cases. Archivos del Instituto de Cardiologia de Mexico. 55(2):153-64, 1985 Mar-Apr • Mavroudis C, et al. Coronary Artery Fistulas in Infants and Children: A Surgical Review and Discussion of Coil Embolization. Ann Thorac Surg. 1997 May;63(5):1235-42. • Kamiya H, et al. Surgical treatment of congenital coronary artery fistulas: 27 years' experience and a review of the literature. Journal of Cardiac Surgery. 17(2):173-7, 2002 Mar-Apr

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