Imaging features of thirteen cases of coronary-to-bronchial artery micro-fistula and the related clinical analyses

Objective: To investigate imaging features and clinical characteristics of the small coronary-bronchial artery fistula (CBF). Methods: By retrospective analysis of image data from May 2007 to November 2011 for coronary angiography in 30284 patients without chronic lung or pulmonary vascular disease patients, 13 cases of small CBF (diameter of the end of fistula near coronary artery < 2 mm) were detected. Incidence of CBF was counted, its morphology was described, and its clinical features were preliminarily analyzed and summarized. Independent sample t test and χ² test were used to compare diameters and incidences of CBF originating from left and right coronary arteries. Results: In this study primary CBF detection rate was 0.043% (13/30284). The ends of CBFs near coronary arteries were slender and their diameter average was (1.57 ± 0.75) mm. In this study all of the CBF were from the right coronary artery and left circumflex coronary artery, finding no cases starting from the left anterior descending coronary artery. There was no significant difference between incidence of CBFs originating from the right coronary artery and left circumflex coronary artery coronary and the diameters of CBFs. In 13 cases of CBF, 9 cases of myocardial ischemic symptoms were caused by coronary artery stenosis, which was proven by angiography; Four cases without myocardial ischemic symptoms or with very atypical symptoms were finally diagnosed as cardiac neurosis. After branching, the CBF diameters of these coronary arteries were seen no evidently reduced, which suggested that the coronary bypass had less blood flow, and therefore had no significant hemodynamic significance. Conclusions: Congenital CBF can exist in populations without chronic lung or pulmonary vascular disease. The main image features are that their diameters were small and all originate from the right coronary artery and left circumflex coronary artery. The most fundamental clinical features are that there're no symptoms of myocardial ischemia due to coronary artery steal and no obviously hemodynamic significance. It is important to well recognize this type of CBF for enriching radiographic knowledge, identifying various anatomic variations, and carrying out clinical diagnosis and treatment. (authors)