Coronary artery fistulae (CAF) are uncommon congenital or acquired coronary anomalies. A CAF occurs when a coronary artery bypasses the myocardial capillary bed to directly communicate with a cardiac chamber, a great vessel, or another vascular structure. Many CAFs are found by chance. If haemodynamically significant, a CAF may cause a variety of phenomena e.g., myocardial ischaemia, arrhythmias, heart failure, pulmonary hypertension, infective endocarditis/endarteritis, aneurysm formation, and late thrombotic complication. Management is anatomy-driven and dependent on the precise definition of the CAF’s origin, course, termination, multiplicity, associated coronary remodeling, and complications, together with an assessment of physiological relevance. Invasive coronary angiography is indispensable for real-time haemodynamics and transcatheter therapy, yet the two-dimensional projection nature can incompletely characterize complex CAF anatomy. Gated computed tomography coronary angiography (CTCA) produces high-resolution volumetric imaging with robust three-dimensional (3D) reconstruction and is central to contemporary diagnosis, quantitative risk stratification, procedural planning, and follow-up. This review examines the role of CTCA for the diagnosis and management of CAF and aims to provide a comprehensive overview for physicians managing this esoteric group of patients.
Saber et al. (Tue,) studied this question.