title: Dual origin multiple plexus-like coronary to pulmonary artery fistulas - Consideration of their etiology and therapeutic strategy.
abstract: Multiple plexus-like coronary to pulmonary fistulas (CAPFs) originating from bilateral coronary arteries are a rare type of coronary artery fistula (CAF). Their etiology and therapeutic strategy are discussed.
  
  
  
  Three patients were diagnosed with dual origin plexus-like CAFs drained to the pulmonary artery trunk. Their ages ranged from 40 to 78 years. Enhanced computed tomography could clearly demonstrate three-dimensional anatomy of CAPFs. Four catheter interventions were performed in all 3 patients. Antegrade approach was applied in 2 procedures and retrograde approach in 2 procedures. A detachable coil was used in 3 procedures and a combination of a vascular plug and detachable coils for 1 procedure. The effective occlusion was achieved in all patients without complications. Follow-up myocardial scintigraphy showed no perfusion defect in all patients.
  
  
  
  CAPFs in our cases, which developed in their adulthood, anatomically correspond with the vasa vasorum of the proximal of the great arteries. The dual origin multiple plexus-like CAPFs might develop from the vasa vasorum of the proximal portion of the great arteries with age. The antegrade approach would be effective because even dual origin multiple plexus-like CAFs converged and drained to a single major exit of the pulmonary trunk. Catheter occlusion could be feasible and safe for dual origin multiple plexus-like CAPFs.
authors.affiliation: Pediatric Cardiology, Heart Institute, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: psugiyama@hij.twmu.ac.jp.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sugiyama
authors.affiliation: Pediatric Cardiology, Heart Institute, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Tetsuko
authors.initials: T
authors.lastname: Ishii
authors.affiliation: Pediatric Cardiology, Heart Institute, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Nakanishi
authors.affiliation: Pediatric Cardiology, Heart Institute, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: In-Sam
authors.initials: IS
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D001159:Arterio-Arterial Fistula / Q000000981:diagnostic imaging* / Q000628:therapy*; D006328:Cardiac Catheterization; D000072226:Computed Tomography Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D055989:Septal Occluder Device; D014057:Tomography, X-Ray Computed
keywords: Coronary artery fistula; Detachable coil; Plexus-like formation; Vascular plug