title: Cardiovascular magnetic resonance and computed tomography in the evaluation of aneurysmal coronary-cameral fistula.
abstract: Coronary artery fistulas represent abnormal communications between a coronary artery and a major vessel like venae cavae, pulmonary arteries or veins, the coronary sinus, or a cardiac chamber. The latter is called coronary cameral fistula is a rare condition and is most of the times congenital but can be also post traumatic or post surgical, especially after cardiovascular interventional procedures. Most patients are asymptomatic and coronary-cameral fistulae are discovered incidentally during angiographic evaluation for coronary vascular disorders, while other patients have a clinical presentation ranging from angina pectoris to heart failure. In this article, we report a rare case of an aneurysmal right coronary cameral fistula draining into the left ventricle. Echocardiography usually represents the first diagnostic imaging approach, but often due to a poor acoustic window may not show the entire course of the fistula which is crucial for the final diagnosis. ECG-gated cardiovascular CT may play an important role in the evaluation of the origin, course, termination and morphology of the fistula, its relation to the adjacent anatomical structures as well as the morphology and contractility of the heart. Cardiac MRI instead plays an additional crucial role regarding not only the above mentioned factors but also in estimating the blood flow within the fistula, providing more detailed information about the cardiac function but also about myocardial wall viability.
authors.affiliation: Department of Radiology, CT and MRI unit, Euromedic International, Heraklion, Crete, Greece.
authors.forename: Efstathios E
authors.initials: EE
authors.lastname: Detorakis
authors.affiliation: Department of Cardiology, General Hospital of Heraklion"Venizeleio - Pananeio", Heraklion, Crete, Greece.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Foukarakis
authors.affiliation: Second department of interventional cardiology, Onassis cardiac surgery centre, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Karavolias
authors.affiliation: Department of Cardiology, General Hospital of Heraklion"Venizeleio - Pananeio", Heraklion, Crete, Greece.
authors.forename: Alkiviades
authors.initials: A
authors.lastname: Dermitzakis
mesh_terms: D000328:Adult; D003323:Coronary Aneurysm / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography; D016157:Vascular Fistula / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery
keywords: Coronary artery fistula; Coronary-cameral fistula; cardiovascular CT; cardiovascular MR; image reformats; late gadolinium enhancement