Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-10T04:01:06.946Z Has data issue: false hasContentIssue false
  • English
  • Français

Incidentally detected small fistula flows in pulmonary artery by colour Doppler: echocardiographic findings and follow-up results

Published online by Cambridge University Press:  30 October 2019

Sezen Ugan Atik Open the ORCID record for Sezen Ugan Atik [Opens in a new window]  and
Irfan Levent Saltik
Sezen Ugan Atik*
Affiliation:
Department of Pediatric Cardiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
Irfan Levent Saltik
Affiliation:
Department of Pediatric Cardiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
*
Author for correspondence: S. U. Atik, Department of Pediatric Cardiology, Istanbul University, Cerrahpaşa Medical Faculty, İstanbul, Turkey. Tel: +90506 367 21 88; Fax: +90 (212) 632 00 50; E-mail: sezenugan@hotmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Abnormal small fistulous flows in the pulmonary artery were detected on routine transthoracic echocardiography in asymptomatic patients by colour Doppler echocardiography. The most likely diagnosis is small coronary artery-pulmonary artery fistulas. We evaluated the clinical, echocardiographic, and follow-up findings of 101 patients. The mean age at first echocardiographic evaluation was 4.3 ± 4.2 years. In 79 (78.2%) of the patients, fistula flow in the pulmonary artery was diagnosed at the first presentation and the remaining 22 patients (21.8%) were diagnosed between the 2nd and 10th examination. The echocardiography indication was cardiac murmur in 42 (41.6%), routine cardiac control in 30 (29.7%), additional CHD in 14 (13.8%), non-specific chest pain in 11 (10.9%), suspicion of inflammatory heart disease in 2 (2%), and syncope in 2 (2%) patients. In 70 (69.3%) patients, fistulous flow was located in the anterior aspect of the main pulmonary artery, in 23 (22.8%) patients on the aortic side of the pulmonary artery and in 8 (7.9%) patients on the right pulmonary artery. Additional cardiac anomalies were ventricular septal defect in 8, patent ductus arteriosus in 6, atrial septal defect in 5, mitral valve prolapse in 4, coarctation of aorta in 4, bicuspid aortic valve in 3, and Kawasaki syndrome in 1 patient. Sixty-four patients (63.3%) were followed during a mean of 52.6 ± 43.7 months. Spontaneous closure was detected in only three patients; the others remained almost unchanged during the follow-up. Since the fistulas are thin and hemodynamically insignificant, echocardiography is an appropriate method to monitor these patients without performing any invasive diagnostic procedures for the fistula source.

Keywords

Pulmonary arterychildrencoronary artery fistulaechocardiography
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 12 , December 2019 , pp. 1435 - 1439
Copyright
© Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Gowda, RM, Vasavada, BC, Khan, IA. Coronary artery fistulas: clinical and therapeutic considerations. Int J Cardiol 2006; 107: 7–10.10.1016/j.ijcard.2005.01.067CrossRefGoogle ScholarPubMed
Lai, WW, Geva, T, Shirali, GS, et al. Task Force of the Pediatric Council of the American Society of Echocardiography; Pediatric Council of the American Society of Echocardiography. Guidelines and standards for performance of a pediatric echocardiogram: a report from the Task Force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr 2006; 19: 1413–1430.10.1016/j.echo.2006.09.001CrossRefGoogle ScholarPubMed
Pastore, S, De Cunto, A, Benettoni, A, Berton, E, Taddio, A, Lepore, L. The resurgence of rheumatic fever in a developed country area: the role of echocardiography. Rheumatology 2011; 50: 396–400.10.1093/rheumatology/keq290CrossRefGoogle Scholar
Holmes, DR , Jr, Cohen, H, Katz, WE, Reeder, GS. Patent foramen ovale, systemic embolization and closure. Curr Probl Cardiol 2004; 29: 56–94.10.1016/j.cpcardiol.2003.12.001CrossRefGoogle ScholarPubMed
Chang, JK, Jien, WY, Chen, HL, Hsieh, KS. Color Doppler echocardiographic study on the incidence and natural history of early-infancy muscular ventricular septal defect. Pediatr Neonatol 2011; 52: 256–260.10.1016/j.pedneo.2011.06.003CrossRefGoogle Scholar
Chehab, G, Saliba, Z, El-Rassi, I. The silent patent ductus arteriosus. J Med Liban 2008; 56: 7–10.Google ScholarPubMed
Sherwood, MC, Rockenmacher, S, Colan, SD, Geva, T. Prognostic significance of clinically silent coronary artery fistulas. Am J Cardiol 1999; 83: 407–411.10.1016/S0002-9149(98)00878-9CrossRefGoogle ScholarPubMed
Chen, BH, Lin, CC, Weng, KP, Wu, HW, Chien, JH, Huang, SM. Echocardiographic diagnosis of incidentally found left coronary artery to pulmonary artery fistula in an 11-year-old girl. Acta Cardiol Sin 2016; 32: 359–362.Google Scholar
Seol, SH, Seo, GW, Song, PS, et al. Coronary-pulmonary artery fistula-multiple diagnostic imaging modalities. J Thorac Dis 2014; 6: E27–E29.Google ScholarPubMed
Challoumas, D, Pericleous, A, Dimitrakaki, IA, Danelatos, C, Dimitrakakis, G. Coronary arteriovenous fistulae: a review. Int J Angiol 2014; 23: 1–10.Google ScholarPubMed
Buccheri, D, Chirco, PR, Geraci, S, Caramanno, G, Cortese, B. Coronary artery fistulae: anatomy, diagnosis and management strategies. Heart Lung Circ 2018; 27: 940–951.10.1016/j.hlc.2017.07.014CrossRefGoogle ScholarPubMed
Warnes, CA, Williams, RG, Bashore, TM, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 52: e143–e263.10.1016/j.jacc.2008.10.001CrossRefGoogle Scholar
Balanescu, S, Sangiorgi, G, Castelvecchio, S, Medda, M, Inglese, L. Coronary artery fistulas: clinical consequences and methods of closure. A literature review. Ital Heart J 2001; 2: 669–676.Google ScholarPubMed
Latson, LA. Coronary artery fistulas: how to manage them. Catheter Cardiovasc Interv 2007; 70: 110–116.10.1002/ccd.21125CrossRefGoogle Scholar
Said, SA, Lam, J, van der Werf, T. Solitary coronary artery fistulas: a congenital anomaly in children and adults. A contemporary review. Congenit Heart Dis 2006; 1: 63–76.10.1111/j.1747-0803.2006.00012.xCrossRefGoogle ScholarPubMed
Schleich, JM, Rey, C, Gewillig, M, Bozio, A. Spontaneous closure of congenital coronary artery fistulas. Heart 2001; 85: E6.10.1136/heart.85.4.e6CrossRefGoogle ScholarPubMed
Wayangankar, SA, Payne, J, Po, S, Sivaram, CA. Serendipitous discovery of a right coronary artery to right pulmonary artery fistula by transesophageal echocardiogram. Echocardiography 2013; 30: E87–E88.10.1111/echo.12070CrossRefGoogle ScholarPubMed
DeBakey, ME, Lawrie, GM. Right coronary artery-to-right pulmonary artery fistula: surgical correction. J Thorac Cardiovasc Surg 1980; 80: 225–227.10.1016/S0022-5223(19)37794-3CrossRefGoogle ScholarPubMed
Lo, MH, Lin, IC, Hsieh, KS, et al. Mid- to long-term follow-up of pediatric patients with coronary artery fistula. J Formos Med Assoc 2016; 115: 571–576.10.1016/j.jfma.2015.05.015CrossRefGoogle ScholarPubMed
Ruberti, U, Odero, A, Arpesani, A, et al. Internal mammary artery to pulmonary artery fistula. J Cardiovasc Surg (Torino) 1986; 27: 734–736.Google ScholarPubMed
Akahane, T, Kurokawa, Y, Takahashi, T, Satomi, S, Sasaki, H. A case of systemic artery to pulmonary vessel fistula. Nihon Kyobu Geka Gakkai Zasshi 1996; 44: 2196–2199.Google ScholarPubMed
Osada, H, Nakajima, H. Effort angina with coronary-pulmonary and bronchial-pulmonary artery fistulae. Asian Cardiovasc Thorac Ann 2014; 22: 502.10.1177/0218492312475229CrossRefGoogle ScholarPubMed
Holzer, R, Johnson, R, Ciotti, G, Pozzi, M, Kitchiner, D. Review of an institutional experience of coronary arterial fistulas in childhood set in context of review of the literature. Cardiol Young 2004; 14: 380–385.10.1017/S1047951104004056CrossRefGoogle ScholarPubMed
Wong, KT, Menahem, S. Coronary arterial fistulas in childhood. Cardiol Young 2000; 10: 15–20.10.1017/S1047951100006326CrossRefGoogle Scholar
Liang, CD, Kuo, HC, Yang, KD, Wang, CL, Ko, SF. Coronary artery fistula associated with Kawasaki disease. Am Heart J 2009; 157: 584–588.10.1016/j.ahj.2008.11.020CrossRefGoogle ScholarPubMed

Atik and Saltik supplementary material

Atik and Saltik supplementary material 1

Download Atik and Saltik supplementary material(Video)
Video 1.1 MB

Atik and Saltik supplementary material

Atik and Saltik supplementary material 2

Download Atik and Saltik supplementary material(Video)
Video 1 MB

Atik and Saltik supplementary material

Atik and Saltik supplementary material 3

Download Atik and Saltik supplementary material(Video)
Video 265.9 KB