Skip to main content
NCBI home page
Korean Journal of Radiology logoLink to Korean Journal of Radiology
. 2021 Sep 13;22(12):2062–2072. doi: 10.3348/kjr.2021.0336

Imaging Findings of Coronary Artery Fistula in Children: A Pictorial Review

Hyun Woo Goo 1,✉
PMCID: PMC8628148  PMID: 34564965

Abstract

Coronary artery fistula, defined as an abnormal communication between the coronary arteries and a cardiac chamber (most commonly) or a thoracic great vessel, may result in hemodynamically significant problems due to vascular shunting in children. Echocardiography, cardiac catheterization, cardiac MRI, and cardiac CT may be used to evaluate coronary artery fistula in children. Recently, CT has played a pivotal role for the accurate diagnosis of coronary artery fistula in children. Surgical or interventional treatment is performed for hemodynamically significant coronary artery fistulas. In this pictorial review, the detailed imaging findings of coronary artery fistula in children are described.

Keywords: Cardiac catheterization, Children, Cardiac CT, Coronary artery anomalies, Echocardiography

INTRODUCTION

Coronary artery fistula, defined as a rare congenital or acquired abnormal communication between the coronary arteries and a cardiac chamber or a thoracic great vessel without an intervening capillary network, was first described in 1865 by Krause [1]. The prevalence of coronary artery fistula is estimated to be 0.002% in the general population, and has been identified in 0.05%–0.25% of patients who underwent catheter coronary angiography [2,3]. More recently, the reported prevalence of coronary artery fistula determined with coronary CT angiography has been relatively high, with a range of 0.19%–0.91% [4,5,6].

Congenital coronary artery fistulas are more common (> 90%) than acquired ones [7]. Based on the drainage site of the fistula, the anomaly can be classified as coronary cameral fistula (draining into a cardiac chamber), coronary-to-pulmonary artery fistula, coronary artery-to-coronary sinus (or any other cardiac vein) fistula, and coronary artery-to-bronchial artery fistula [7]. Among them, coronary cameral fistula is the most common type detected on coronary angiography [7]. In adults, coronary-to-pulmonary artery fistula has been increasingly detected with the increased use of coronary CT angiography, and is currently the most common coronary artery fistula type, accounting for 76.8%–89.5% of cases [4,8,9]. In contrast, coronary-to-pulmonary artery fistula is rare in children, and only 7.5% of patients with coronary-to-pulmonary artery fistula were younger than 18 years old [5].

Coronary artery fistula occurs in isolation in 55.0%–88.0% of cases, whereas 5.0%–30.0% of cases are associated with other congenital heart diseases [10]. Associated congenital defects include atrial septal defect, ventricular septal defect, tetralogy of Fallot, patent ductus arteriosus, and pulmonary atresia with an intact ventricular septum [11].

Imaging findings of coronary artery fistula in adults have been frequently described in the literature [3,4,6,7,8,9,12,13,14], while imaging findings of coronary artery fistula in children have been rarely reported [5,15]. Therefore, this paper aimed to illustrate the detailed imaging findings of coronary artery fistula in children.

Clinical Scenario and Hemodynamic Significance

Unlike adult patients with coronary artery fistula who are usually asymptomatic, the majority of pediatric patients are symptomatic, as children commonly develop large fistulous connections [15]. The most common clinical presentation of coronary artery fistula in children is a continuous murmur. With increasing patient age, the fistula gradually enlarges with increased shunt flow via the fistula. In contrast, spontaneous closure of the fistula is rare, accounting for 1.0%–2.0% of cases [7]. Aneurysmal changes are frequently seen in the distal segments of coronary artery fistulas (24.2%–87.1%) [4,6,9,12,13]. The amount of shunt flow depends on the size of the fistula, the presence of stenosis, and the pressure level at the drainage site. According to the drainage site, the shunt flow may be left to right or left to left, and may even be right to left in cases with hypertensive right ventricles. When the shunt is large enough to decrease perfusion distal to the fistula, a coronary steal phenomenon may occur. Owing to this hemodynamic effect of coronary artery fistulas, various complications, including myocardial ischemia, heart failure, arrhythmia, and infective endocarditis, have been described in adults [7].

Diagnostic Imaging Modalities

Transthoracic echocardiography may show a large coronary artery fistula of typically greater than 3 mm in diameter [16]. However, its diagnostic accuracy for identifying coronary artery fistula is low, and was only 19.1% in a study of 72 adult patients with coronary-to-pulmonary artery fistula [13]. Reports on the diagnostic accuracy of transthoracic echocardiography for identifying coronary artery fistula in children are lacking. Although the acoustic window of transthoracic echocardiography is less limited in children compared to adults, its diagnostic accuracy is expected to remain insufficient to be used as a confirmatory imaging test for coronary artery fistula in children. Therefore, additional imaging methods, including catheter coronary angiography, coronary CT angiography, and coronary MR angiography, are required to make accurate diagnosis of coronary artery fistula.

The reported diagnostic accuracy of catheter coronary angiography is in the range of 35.0%–50.0% [17,18]. Due to procedure-related complications, radiation exposure, and the use of iodinated contrast agents, diagnostic catheter coronary angiography should not be primarily used for coronary artery fistulas, especially in young children.

Coronary MR angiography does not involve ionizing radiation, which may be considered a merit in pediatric imaging. However, its diagnostic accuracy in children is relatively low, mainly due to its low spatial resolution [19]. Lengthy examination time, commonly requiring deep sedation or general anesthesia, is another limitation of pediatric coronary MR angiography [20]. Consequently, cardiac MRI has been rarely used for the diagnosis of coronary artery fistula [21].

Coronary CT angiography is currently considered the imaging modality of choice for evaluating coronary artery fistula in adults [4,6,7,8,9,12,13,14]. Coronary artery visibility on electrocardiography-synchronized CT is also significantly improved in children [22,23,24]; therefore, cardiac CT has been useful for evaluating coronary artery anomalies such as coronary artery fistula in children [5,15,20,25,26,27]. Three-dimensional CT imaging with a thinner slab over the area of interest is especially useful for the treatment planning of coronary artery fistulas. However, coronary artery fistulas with mildly dilated distal coronary artery segments and small drainage sites, particularly seen in young children, may be missed given the significantly low visibility of distal coronary artery segments on cardiac CT [28]. In this case, ascending aortography or selective catheter coronary angiography may be helpful in making the correct diagnosis.

Coronary Cameral Fistula

Coronary cameral fistula is the most common type of coronary artery fistula in children, accounting for 75.0%–100.0% of cases [5,15]. Coronary cameral fistula in children most commonly originates from the right coronary artery, followed by the left coronary artery (Figs. 1, 2, 3, 4, 5) [5,15]. In this type of fistula, the coronary arterial origin is usually single and rarely multiple [5]. When the fistula occurs in association with pulmonary atresia and an intact ventricular septum, the origin is frequently multiple. The most common draining site of coronary cameral fistula in children is the right ventricle, followed by the left ventricle [15] (Figs. 1, 2, 3, 4, 5), and less frequently, the right or left atrium (Fig. 6). Coronary cameral fistula can be easily detected on imaging studies because the affected coronary artery is usually large.

Fig. 1. Coronary cameral fistula between the right coronary artery and the RV.

Fig. 1

Open in a new tab

A. Initial frontal volume-rendered CT image showing the diffusely dilated right coronary artery in a 5-month-old boy. B, C. Initial inferior volume-rendered CT images with a full slab (B) and with a thinner slab (C) demonstrating the single drainage site of the fistula into the inferomedial basal portion of the RV. Two narrowings (arrows) are noted at the drainage site. D, E. Follow-up frontal (D) and inferior (E) volume-rendered CT images performed 8 years later showing increased dilatation of the right coronary artery and the development of aneurysmal change (asterisk) at the drainage site. The two narrowings (arrows) showed interval increase in diameter due to increased left-to-right shunt through the fistula. LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle

Fig. 2. Coronary cameral fistula between the LAD artery and the RV in a 5-year-old boy.

Fig. 2

Open in a new tab

A. Oblique lateral volume-rendered CT image showing the diffusely dilated LAD artery and a D branch in a 5-year-old boy. B, C. Inferior volume-rendered CT images with a full slab (B) and with a thinner slab (C) demonstrating the single drainage site (arrows) of the fistula into the inferomedial basal portion of the RV. D = diagonal, LA = left atrium, LAD = left anterior descending, LV = left ventricle, RA = right atrium, RV = right ventricle

Fig. 3. Coronary cameral fistula between the left circumflex artery and the RV in a 1-month-old boy.

Fig. 3

Open in a new tab

A. Oblique lateral volume-rendered CT image with frontal cut showing the diffusely dilated left circumflex artery (arrows) anomalously connecting to the inferomedial basal portion of the RV in a 1-month-old boy. B. Oblique lateral catheter ascending aortographic image showing the diffusely dilated left circumflex artery (asterisks) draining into the inferomedial basal portion of the RV (long arrow). A normal right coronary artery (short arrows) was noted. AA = ascending aorta, MPA = main pulmonary artery, RV = right ventricle

Fig. 4. Coronary cameral fistula between the conal branch of the right coronary artery and the RV.

Fig. 4

Open in a new tab

A. Initial superior volume-rendered CT image showing the dilated conal branch (short arrows) draining into the outflow tract of the RV (long arrow) in a 9-month-old girl. B. Color-coded volume-rendered CT image demonstrating the coronary cameral fistula and the AA in red, and the normal right and left coronary arteries in blue. C, D. Frontal selective catheter right coronary arteriographic images performed 5 years later confirming the coronary cameral fistula (C), and an occluding device (arrow) was placed in the distal part of the fistula (D). AA = ascending aorta, LV = left ventricle, MPA = main pulmonary artery, RA = right atrium, RV = right ventricle

Fig. 5. Coronary cameral fistula between the right coronary artery and the LV in an 8-month-old girl.

Fig. 5

Open in a new tab

A. Superior volume-rendered CT image showing the diffusely dilated right coronary artery (asterisks) in an 8-month-old girl. B. Inferior volume-rendered CT image revealing the abnormal connection (arrow) between the right coronary artery and the LV. C. Curved planar reformatted CT image demonstrating the entire course (arrows) of the fistula. AA = ascending aorta, CS = coronary sinus, LV = left ventricle, RA = right atrium, RV = right ventricle

Fig. 6. Coronary cameral fistula between the right coronary artery and the RA in an 11-day-old boy.

Fig. 6

Open in a new tab

A. Oblique coronal CT image showing the severely dilated origin and proximal portion of the right coronary artery (asterisk) in an 11-day-old boy. The left coronary artery (arrows) was normal in size. B. Oblique axial CT image revealing the fistulous connection (arrow) between the dilated proximal right coronary artery (asterisks) and the RA. AA = ascending aorta, DA = descending aorta, LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle

Coronary-to-Pulmonary Artery Fistula

As previously mentioned, coronary-to-pulmonary artery fistula is predominantly found in adults and rarely in children. In contrast to coronary cameral fistula, this fistula type most commonly arises from the proximal left anterior descending artery (45.3%–93.1%) and the proximal right coronary artery (24.5%–76.4%), and multiple origins are fairly common (30.2%–69.4%) [5,8,12,13,29]. Coronary-to-pulmonary-artery fistulas typically course anteriorly to the main pulmonary artery and drain into the anterolateral aspect, and often form a vascular network with multiple origins. Coronary arteries supplying the central pulmonary artery, as one of the major aortopulmonary collateral arteries, have been identified with ascending aortography or selective catheter coronary angiography in 10.0% of pediatric patients with pulmonary atresia and ventricular septal defect [30]. However, the tiny connection between the coronary artery and the central pulmonary artery may be easily missed on non-selective catheter angiography and other imaging modalities, including echocardiography, CT, and MRI [13].

Coronary Artery-to-Coronary Sinus (or Any Other Cardiac Vein) Fistula

Coronary artery fistulas terminating in the coronary venous system are relatively rare, accounting for 7.0% of cases [7]. The fistula may terminate in the coronary sinus (Fig. 7) or in its tributary cardiac veins (Fig. 8). Coronary artery-to-coronary sinus fistulas frequently present with congestive heart failure [31].

Fig. 7. Coronary artery-to-coronary sinus fistula.

Fig. 7

Open in a new tab

A–C. Initial oblique coronal CT images showing the severely dilated left circumflex artery (asterisks) anomalously draining into the dilated CS in a 3-day-old girl. D. Frontal selective catheter left circumflex arteriographic image performed on the same day confirming the diagnosis of coronary artery-to-coronary sinus fistula. E. Follow-up oblique coronal CT image performed one month after surgical ligation of the fistula showing stumps (arrows) of the left circumflex artery and the CS. AA = ascending aorta, CS = coronary sinus, LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle

Fig. 8. Coronary artery-to-middle cardiac vein fistula.

Fig. 8

Open in a new tab

A. Axial coronary MR angiographic image showing a fusiform enlarged vascular space (asterisks) at the basal portion of the RV in a 2-year-old boy. B, C. Cardiac volume-rendered CT images performed 3 years later showing the mildly dilated left anterior descending artery (arrows). However, the enlarged vascular space (asterisks) detected on MRI was barely seen. D, E. Frontal selective catheter left coronary arteriographic images performed 4 years later demonstrating the abnormal connection (arrow) between the left anterior descending artery and the middle cardiac vein, delayed opacification of the enlarged vascular space (asterisks), and the cardiac veins. CS = coronary sinus, LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle

Ventriculo-Coronary Arterial Connections in Pulmonary Atresia with an Intact Ventricular Septum

Ventriculo-coronary arterial communications in pulmonary atresia with an intact ventricular septum are defined as abnormal vascular connections between the hypoplastic right ventricle and the coronary artery. Ventriculo-coronary arterial communications are present in approximately 40.0% of cases [32]. Such communications typically occur in cases with severe hypoplasia and hypertrophy of the right ventricle [32]. Right ventricle-dependent coronary arterial circulations may cause right ventricular steal phenomenon if the affected coronary arteries are patent, and may cause myocardial ischemia or infarction when coronary artery obstruction coexists. For the imaging diagnosis of a right ventricle-dependent coronary arterial circulation, there should be angiographic evidence of myocardial perfusion through the fistulous communication. Right ventricle-dependent coronary arterial circulation occurs in slightly over half of the cases with ventriculo-coronary arterial communications, and is considered a risk factor for poor outcomes in patients undergoing an attempted biventricular repair, in which the right ventricle is decompressed and the coronary arterial pressure is subsequently dropped [32]. Therefore, Fontan operation without cardiopulmonary bypass is now preferred to avoid adverse coronary arterial events, as right ventricular unloading during cardiopulmonary bypass reduces coronary perfusion pressure in right ventricle-dependent areas, and results in myocardial ischemia [32]. Ventriculo-coronary arterial connections have been traditionally observed with cardiac catheter angiography [32], but recently, such abnormal fistulous connections can be delineated with coronary CT angiography (Figs. 9, 10) [5].

Fig. 9. Ventriculo-coronary arterial connections in a 1-day-old girl with pulmonary atresia, an intact ventricular septum, and hypoplastic tricuspid valve.

Fig. 9

Open in a new tab

A, B. Oblique superior volume-rendered cardiac CT images obtained at end-systolic (A) and end-diastolic (B) phases showing the severely dilated left anterior descending artery and the mildly dilated right coronary artery connected to the hypoplastic RV at multiple sites in a 1-day-old girl. Notably, diastolic flow to the left anterior descending artery was significantly compromised (arrows), which may contribute to myocardial ischemia. C. Oblique axial CT image demonstrating pulmonary atresia (arrow) with confluent central branch pulmonary arteries. D. Four-chamber CT image showing the hypoplastic tricuspid valve (arrows), the hypoplastic RV, and the intact ventricular septum. AA = ascending aorta, DA = descending aorta, LA = left atrium, LPA = left pulmonary artery, LV = left ventricle, RA = right atrium, RPA = right pulmonary artery, RV = right ventricle

Fig. 10. Ventriculo-coronary arterial connections in pulmonary atresia and an intact ventricular septum.

Fig. 10

Open in a new tab

A. Initial frontal catheter right ventriculographic image showing multiple abnormal connections between the hypoplastic RV and the dilated coronary arteries in a 5-year-old boy. B. Follow-up frontal selective catheter left coronary arteriographic image obtained after coil embolization (long arrow) of the fistulous connection between the hypoplastic RV and the right coronary artery 2 years later showing residual connections (short arrows) between the hypoplastic RV and the dilated left anterior descending artery. C, D. Frontal (C) and inferior (D) volume-rendered cardiac CT images performed at the age of 24 years after extracardiac conduit Fontan operation demonstrating residual connections (arrows in C) between the hypoplastic RV and the dilated left anterior descending artery. The right coronary artery remained dilated after coil embolization (long arrow in D), suggesting residual shunt flow between the RV and the right coronary artery. A normal posterolateral branch (short arrows in D) of the right coronary artery was noted. AA = ascending aorta, LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle

Treatment

Coronary artery fistulas should be treated if the fistula is large with substantial shunt flow that may lead to myocardial ischemia, ventricular dysfunction, and congestive heart failure [7,15,33]. Surgical ligation was solely performed before the development of transcatheter closure techniques, and is now used for fistulas not amenable to interventional treatment (Fig. 7). Since its introduction in the early 1980s, transcatheter closure of the fistula has been widely used as an effective and safe treatment for coronary artery fistulas (Fig. 10) [33]. Contraindication to percutaneous transcatheter closure include fistulas draining close to the atrioventricular annulus, fistulas with origins at normal coronary artery branches in proximity to the occlusion site, extreme tortuosity or very small patient size making the procedure difficult, a wide draining site increasing the risk of coil migration, as well as multiple communications and drainage sites [7,15]. Coronary artery-to-coronary sinus fistula increases the risk for post-treatment adverse events such as coronary artery thrombosis and myocardial infarction [34].

CONCLUSION

In this article, the imaging findings of coronary artery fistula in children have been described. Coronary cameral fistula is the most common type of coronary artery fistula in children, and can be accurately diagnosed with CT. However, small or distal parts of other coronary artery fistula types in children may not be clearly depicted on CT, and selective catheter angiography may be necessary to characterize the whole angioarchitecture of such coronary artery fistulas. The detailed angioarchitecture delineated on coronary CT angiography is not only useful for differentiating coronary artery fistulas from other abnormalities manifested as dilated coronary arteries, including anomalous coronary artery origin from the pulmonary artery and Kawasaki disease, but is also crucial for treatment planning and post-treatment evaluation.

Footnotes

Conflicts of Interest: The author has no potential conflicts of interest to disclose.

References

  • 1.Krause W. Über den Ursprung einer akzessorischen A. coronaria aus der A. pulmonalis. Z Ratl Med. 1865;24:225–227. [Google Scholar]
  • 2.Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn. 1990;21:28–40. doi: 10.1002/ccd.1810210110. [DOI] [PubMed] [Google Scholar]
  • 3.Vavuranakis M, Bush CA, Boudoulas H. Coronary artery fistulas in adults: incidence, angiographic characteristics, natural history. Cathet Cardiovasc Diagn. 1995;35:116–120. doi: 10.1002/ccd.1810350207. [DOI] [PubMed] [Google Scholar]
  • 4.Zhou K, Kong L, Wang Y, Li S, Song L, Wang Z, et al. Coronary artery fistula in adults: evaluation with dual-source CT coronary angiography. Br J Radiol. 2015;88:20140754. doi: 10.1259/bjr.20140754. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Li N, Zhao P, Wu D, Liang C. Coronary artery fistulas detected with coronary CT angiography: a pictorial review of 73 cases. Br J Radiol. 2020;93:20190523. doi: 10.1259/bjr.20190523. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Ouchi K, Sakuma T, Ojiri H. Coronary artery fistula in adults: incidence and appearance on cardiac computed tomography and comparison of detectability and hemodynamic effects with those on transthoracic echocardiography. J Cardiol. 2020;76:593–600. doi: 10.1016/j.jjcc.2020.06.005. [DOI] [PubMed] [Google Scholar]
  • 7.Yun G, Nam TH, Chun EJ. Coronary artery fistulas: pathophysiology, imaging findings, and management. Radiographics. 2018;38:688–703. doi: 10.1148/rg.2018170158. [DOI] [PubMed] [Google Scholar]
  • 8.Kim MS, Jung JI, Chun HJ. Coronary to pulmonary artery fistula: morphologic features at multidetector CT. Int J Cardiovasc Imaging. 2010;26:273–280. doi: 10.1007/s10554-010-9711-3. [DOI] [PubMed] [Google Scholar]
  • 9.Lim JJ, Jung JI, Lee BY, Lee HG. Prevalence and types of coronary artery fistulas detected with coronary CT angiography. AJR Am J Roentgenol. 2014;203:W237–W243. doi: 10.2214/AJR.13.11613. [DOI] [PubMed] [Google Scholar]
  • 10.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. doi: 10.1111/j.1747-0803.2006.00012.x. [DOI] [PubMed] [Google Scholar]
  • 11.Fernandes ED, Kadivar H, Hallman GL, Reul GJ, Ott DA, Cooley DA. Congenital malformations of the coronary arteries: the Texas Heart Institute experience. Ann Thorac Surg. 1992;54:732–740. doi: 10.1016/0003-4975(92)91019-6. [DOI] [PubMed] [Google Scholar]
  • 12.Lee CM, Song SY, Jeon SC, Park CK, Choi YW, Lee Y. Characteristics of coronary artery to pulmonary artery fistula on coronary computed tomography angiography. J Comput Assist Tomogr. 2016;40:398–401. doi: 10.1097/RCT.0000000000000370. [DOI] [PubMed] [Google Scholar]
  • 13.Li JL, Huang L, Zhu W, Ye WT, Yan LF, Zhong XM, et al. The evaluation of coronary artery-to-pulmonary artery fistula in adulthood on 256-slice CT coronary angiography: comparison with coronary catheter angiography and transthoracic echocardiography. J Cardiovasc Comput Tomogr. 2019;13:75–80. doi: 10.1016/j.jcct.2018.10.013. [DOI] [PubMed] [Google Scholar]
  • 14.Ghrairi A, Menager-Gangloff C, Favier JP, Bonnet P, Dacher JN. CT angiography features of coronary-pulmonary artery fistula. Diagn Interv Imaging. 2017;98:905–906. doi: 10.1016/j.diii.2017.08.002. [DOI] [PubMed] [Google Scholar]
  • 15.Hu X, Wu L, Liu F, Shen Q, Pa M, Huang G. Coronary artery fistulas in children. Evaluation with 64-slice multidetector CT. Herz. 2013;38:729–735. doi: 10.1007/s00059-013-3786-2. [DOI] [PubMed] [Google Scholar]
  • 16.Zhang P, Cai G, Chen J, Wang Y, Duan S. Echocardiography and 64-multislice computed tomography angiography in diagnosing coronary artery fistula. J Formos Med Assoc. 2010;109:907–912. doi: 10.1016/S0929-6646(10)60138-6. [DOI] [PubMed] [Google Scholar]
  • 17.Shabestari AA, Akhlaghpoor S, Fatehi M. Findings of bilateral coronary to pulmonary artery fistula in 64-multislice computed tomographic angiography: correlation with catheter angiography. J Comput Assist Tomogr. 2008;32:271–273. doi: 10.1097/RCT.0b013e3180683bbe. [DOI] [PubMed] [Google Scholar]
  • 18.Erol C, Seker M. Coronary artery anomalies: the prevalence of origination, course, and termination anomalies of coronary arteries detected by 64-detector computed tomography coronary angiography. J Comput Assist Tomogr. 2011;35:618–624. doi: 10.1097/RCT.0b013e31822aef59. [DOI] [PubMed] [Google Scholar]
  • 19.Tangcharoen T, Bell A, Hegde S, Hussain T, Beerbaum P, Schaeffter T, et al. Detection of coronary artery anomalies in infants and young children with congenital heart disease by using MR imaging. Radiology. 2011;259:240–247. doi: 10.1148/radiol.10100828. [DOI] [PubMed] [Google Scholar]
  • 20.Goo HW. Coronary artery imaging in children. Korean J Radiol. 2015;16:239–250. doi: 10.3348/kjr.2015.16.2.239. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Detorakis EE, Foukarakis E, Karavolias G, Dermitzakis A. Cardiovascular magnetic resonance and computed tomography in the evaluation of aneurysmal coronary-cameral fistula. J Radiol Case Rep. 2015;9:10–21. doi: 10.3941/jrcr.v9i7.2305. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Tsai IC, Lee T, Chen MC, Fu YC, Jan SL, Wang CC, et al. Visualization of neonatal coronary arteries on multidetector row CT: ECG-gated versus non-ECG-gated technique. Pediatr Radiol. 2007;37:818–825. doi: 10.1007/s00247-007-0512-3. [DOI] [PubMed] [Google Scholar]
  • 23.Ben Saad M, Rohnean A, Sigal-Cinqualbre A, Adler G, Paul JF. Evaluation of image quality and radiation dose of thoracic and coronary dual-source CT in 110 infants with congenital heart disease. Pediatr Radiol. 2009;39:668–676. doi: 10.1007/s00247-009-1209-6. [DOI] [PubMed] [Google Scholar]
  • 24.Goo HW, Yang DH. Coronary artery visibility in free-breathing young children with congenital heart disease on cardiac 64-slice CT: dual-source ECG-triggered sequential scan vs. single-source non-ECG-synchronized spiral scan. Pediatr Radiol. 2010;40:1670–1680. doi: 10.1007/s00247-010-1693-8. [DOI] [PubMed] [Google Scholar]
  • 25.Goo HW, Seo DM, Yun TJ, Park JJ, Park IS, Ko JK, et al. Coronary artery anomalies and clinically important anatomy in patients with congenital heart disease: multislice CT findings. Pediatr Radiol. 2009;39:265–273. doi: 10.1007/s00247-008-1111-7. [DOI] [PubMed] [Google Scholar]
  • 26.Goo HW. Identification of coronary artery anatomy on dual-source cardiac computed tomography before arterial switch operation in newborns and young infants: comparison with transthoracic echocardiography. Pediatr Radiol. 2018;48:176–185. doi: 10.1007/s00247-017-4004-9. [DOI] [PubMed] [Google Scholar]
  • 27.Goo HW. Coronary artery anomalies on preoperative cardiac CT in children with tetralogy of Fallot or Fallot type of double outlet right ventricle: comparison with surgical findings. Int J Cardiovasc Imaging. 2018;34:1997–2009. doi: 10.1007/s10554-018-1422-1. [DOI] [PubMed] [Google Scholar]
  • 28.Goo HW. Quantitative evaluation of coronary artery visibility on CT angiography in Kawasaki disease: young vs. old children. Int J Cardiovasc Imaging. 2021;37:1085–1092. doi: 10.1007/s10554-020-02054-6. [DOI] [PubMed] [Google Scholar]
  • 29.Verdini D, Vargas D, Kuo A, Ghoshhajra B, Kim P, Murillo H, et al. Coronary-pulmonary artery fistulas: a systematic review. J Thorac Imaging. 2016;31:380–390. doi: 10.1097/RTI.0000000000000232. [DOI] [PubMed] [Google Scholar]
  • 30.Amin Z, McElhinney DB, Reddy VM, Moore P, Hanley FL, Teitel DF. Coronary to pulmonary artery collaterals in patients with pulmonary atresia and ventricular septal defect. Ann Thorac Surg. 2000;70:119–123. doi: 10.1016/s0003-4975(00)01284-4. [DOI] [PubMed] [Google Scholar]
  • 31.Ogden JA, Stansel HC., Jr Coronary arterial fistulas terminating in the coronary venous system. J Thorac Cardiovasc Surg. 1972;63:172–182. [PubMed] [Google Scholar]
  • 32.Freedom RM, Anderson RH, Perrin D. The significance of ventriculo-coronary arterial connections in the setting of pulmonary atresia with an intact ventricular septum. Cardiol Young. 2005;15:447–468. doi: 10.1017/S1047951105001319. [DOI] [PubMed] [Google Scholar]
  • 33.Latson LA. Coronary artery fistulas: how to manage them. Catheter Cardiovasc Interv. 2007;70:110–116. doi: 10.1002/ccd.21125. [DOI] [PubMed] [Google Scholar]
  • 34.Valente AM, Lock JE, Gauvreau K, Rodriguez-Huertas E, Joyce C, Armsby L, et al. Predictors of long-term adverse outcomes in patients with congenital coronary artery fistulae. Circ Cardiovasc Interv. 2010;3:134–139. doi: 10.1161/CIRCINTERVENTIONS.109.883884. [DOI] [PubMed] [Google Scholar]

Articles from Korean Journal of Radiology are provided here courtesy of Korean Society of Radiology

RESOURCES