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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Incidental congenital coronary artery vascular fistulas in adults: Evaluation with adenosine-13N-ammonia PET-CT
Salah AM Said, Aly Agool, Arno HM Moons, Mounir WZ Basalus, Nils RL Wagenaar, Rogier LG Nijhuis, Jutta M Schroeder-Tanka, Riemer HJA Slart
Salah AM Said, Mounir WZ Basalus, Rogier LG Nijhuis, Department of Cardiology, Hospital Group Twente, Almelo-Hengelo 7555 DL, Overijssel, The Netherlands
Aly Agool, Nils RL Wagenaar, Department of Nuclear Medicine, Hospital Group Twente, Almelo-Hengelo 7555 DL, Overijssel, The Netherlands
Arno HM Moons, Department of Cardiology, Slotervaart Hospital, Amsterdam 1066 EC, North Holland, The Netherlands
Jutta M Schroeder-Tanka, Department of Cardiology, Hospital Onze Lieve Vrouwe Gasthuis, Location West, Amsterdam 1061 AE, North Holland, The Netherlands
Riemer HJA Slart, Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
Riemer HJA Slart, Faculty of Science and Technology, Biomedical Photonic Imaging, University of Twente, Enschede 7522 NB, The Netherlands
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.
Institutional review board statement: The study was reviewed and approved by the local medical ethical committee of the Eastern region, Enschede, The Netherlands (ID METC: K18-14, METC/18082.sai).
Informed consent statement: The study was reviewed and approved by the local medical ethical committee and the requirement to obtain informed consent was waived due to the retrospective nature of the report, the Eastern region, Enschede, The Netherlands (ID METC: K18-14, METC/18082.sai).
Conflict-of-interest statement: The authors declare that they have no competing interests.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: 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. See: http://creativecommons.org/licenses/by-nc/4.0/
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@home.nl
Telephone: +31-88-7085286 Fax: +31-88-7085289
Received: June 27, 2018
Peer-review started: June 30, 2018
First decision: July 19, 2018
Revised: August 21, 2018
Accepted: August 30, 2018
Article in press: August 30, 2018
Published online: October 26, 2018
Processing time: 122 Days and 4.5 Hours
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.
Core tip: Congenital coronary artery fistulas are usually detected as a coincidental finding during non-invasive and invasive diagnostic modalities for the assessment of coronary artery disease. Positron emission tomography computed tomography (PET-CT) is not frequently applied for functional assessment. In the current study, five patients underwent adenosine 13N-ammonia PET-CT to assess myocardial perfusion and the functional behavior of the fistula. PET-CT revealed normal myocardial perfusion and ejection fraction in all but one patient, who showed a reduced ejection fraction. Combined with semi-quantitative results, patients with normal flow, revealed by PET-CT, could be treated medically, thereby avoiding the need for transcutaneous or surgical occlusion of the fistulas.
