Introduction
CAFs can be defined as an uncommon abnormal connection between coronary
arteries and either heart chambers or major thoracic vessels, allowing
blood to bypass the usual capillary network in the myocardium. If these
connections terminate in heart chambers, they are termed
coronary-cameral fistulas, whereas those ending in veins are referred to
as coronary arteriovenous fistulas. Congenital forms of CAF are more
frequent, but still only make up just 0.4% of all congenital cardiac
abnormalities. (1) The majority of patients have a solitary CAF,
however, approximately 20% of patients exhibit fistulas originating
from two or more coronary arteries. (2).
The clinical presentation of CAFs varies according to factors such as
the patient’s age, flow volume, the recipient chamber’s resistance, and
the development of myocardial ischemia. Often, the anomaly is
inadvertently discovered during routine examinations or coronary
angiography, with the condition being recognized due to the presence of
a continuous murmur upon examination. (3,4)
Compared to other imaging modalities, computed tomography angiography
(CTA) is highly valuable for the assessment of CAFs due to a shorter
acquisition time and the ability to provide superior temporal and
spatial resolution. Multiplanar reconstruction along with 3D
volume-rendered imaging offers exceptional anatomical details,
encompassing the origin, trajectory, and drainage location of CAFs. This
holds true even for intricate anomalies, thereby establishing its
potential as an essential tool for guiding treatment planning. (5)
Regarding treatment, surgical or catheter-based closure is highly
recommended for symptomatic patients and asymptomatic patients with high
flow shunting, particularly in pediatric cases. Interventional closure
has become the preferred approach, especially in younger patients,
although the method choice also considers fistula anatomy, presence of
other cardiac defects, and the expertise of the interventional
cardiologist. (6)