Đặc điểm hình ảnh và giá trị của chụp cắt lớp vi tính động mạch vành trong chẩn đoán rò động mạch vành đổ vào động mạch phổi: Báo cáo chuỗi ca lâm sàng

Abstract

Objective: To describe the imaging characteristics and diagnostic value of coronary computed tomography angiography (CCTA) in detecting coronary artery fistula (CAF) to the pulmonary artery through a case series report. Subjects and method: Study population: This study was conducted as a case series, including three patients diagnosed with coronary artery fistula draining into the pulmonary artery at 108 Military Central Hospital. Inclusion criteria and indications for CCTA: Patients were included if coronary artery fistula draining into the pulmonary artery was identified on CCTA. CCTA images were required to be of good quality, allowing clear evaluation of the origin, course, and drainage site of the fistula. Complete clinical information and imaging data for analysis were also required. Indications for CCTA included: clinical suspicion of coronary artery disease or coronary artery fistula based on initial assessments (echocardiography, electrocardiography), pre-intervention or pre-surgical anatomical evaluation, and post-treatment follow-up. Patients with stable heart rates (with pharmacological control if necessary), the ability to hold their breath as instructed, and willingness to participate in the study were included in the analysis. Exclusion criteria and contraindications for CCTA: Patients with contraindications or those unsuitable for CCTA were excluded from the study. Exclusion criteria included: severe renal impairment (estimated glomerular filtration rate < 30 mL/min/1.73 m²), history of severe allergy to iodinated contrast agents, pregnancy or suspected pregnancy, and inability to cooperate with breath-holding during image acquisition. Additionally, patients with uncontrolled high or irregular heart rates (such as atrial fibrillation or frequent ectopic beats) that compromise image quality may be excluded if the images are not adequate for analysis. Cases with extensive coronary artery calcification or severe obesity limiting image quality were also considered for exclusion. Patients with uncontrolled coagulopathy, prior coronary intervention or surgery, or incomplete clinical or imaging data were excluded. In the context of coronary artery fistula, patients requiring emergency intervention or immediate hemodynamic assessment were not indicated for CCTA and were instead referred for invasive coronary angiography. Study design: A retrospective descriptive study in the form of a case series. A case series of three patients was examined using CCTA on a 256-detector CT system with 512-slice reconstruction capability (Revolution CT, GE Healthcare). CCTA images were reconstructed using volume rendering (VR), maximum intensity projection (MIP), and multiplanar reconstruction (MPR) techniques to evaluate the origin, course, and drainage site of the fistula. Result: In all three cases, abnormal vascular branches originating from the left anterior descending artery (LAD) were detected, among them, one case additionally had a fistula originating from the right coronary artery (RCA), with a tortuous course and drainage into the pulmonary artery trunk. Conclusion: CCTA is a non-invasive modality that allows accurate evaluation of the anatomy, course, and drainage site of coronary artery fistulas, thereby playing an important role in the diagnostic approach to coronary artery anomalies ^{5, 8}.