PMC7240892_01
Axial maximum intensity projection (MIP) image of multidetector computed tomography (MDCT) (A) shows communication of the fistula with left coronary sinus (thick arrow) and forming a complete loop with the distal limb of the fistula surrounding the right ventricle (arrowheads)
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F1
A prospective gated 64-slice MDCT performed with iodinated contrast revealed the coronary fistula [Figure 1] and origin of confluent pulmonary arteries from patent ductus arteriosus [Figure 2A].
Coronal, axial MIP, and volume rendering image of MDCT (A) shows confluent pulmonary artery originating from a large persistent ductus arteriosus (PDA) (thick arrow). Hypoplastic right ventricle with the fistula (arrow). High-grade narrowing noted (B) at the origin of the right pulmonary artery (arrow). 2D CT image (C) and 3D CT image (D) show communication of the fistula with left coronary sinus (thick arrow) and entering free wall of the right ventricle (arrowhead). The distal limb of fistula is seen to originate from the right ventricle outflow (arrow) to form a complete loop. No other coronary ostium was identified from the aortic sinus
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F2
A prospective gated 64-slice MDCT performed with iodinated contrast revealed the coronary fistula [Figure 1] and origin of confluent pulmonary arteries from patent ductus arteriosus [Figure 2A]. The right pulmonary artery was hypoplastic with a high-grade narrowing at the beginning [Figure 2B]. CT imaging revealed left coronary sinus with a large fistula draining into the free wall of hypoplastic right ventricular cavity [Figures 2C and D]. Another tortuous channel was noted arising from the right ventricular outflow and communicating with proximal limb of the fistula forming a complete loop suggesting a right ventricle to left coronary sinus sinusoid [Figures 2C and D].
2D MDCT image shows (A) origin of left coronary (arrow) and right coronary (arrowheads) artery from the proximal and distal limb of fistula (thick arrow), (B) origin of right coronary artery from distal limb of the fistula (thick arrow) and giving posterior descending artery (arrow) and posterior left ventricular branches (arrowhead), (C) multiple sinusoids are seen to arise from right ventricle coursing to form unnamed coronary arteries (arrows), (D) two of the large sinusoids (arrows) arising from right ventricle (arrowhead) and coursing through the interventricular septum toward left ventricle
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F3
Filling of left and right CA was noted to originate from distal and proximal limb of the sinusoid [Figures 3A and B], respectively. Multiple small sinusoids were noted emerging from the right ventricle along [Figures 3C and D] with the creation of unnamed coronary branches.
Right ventricular angiogram shows (A) origin of the left coronary (arrow) and right coronary (arrowhead) artery from proximal and distal limb of the fistula (thick arrow). The proximal (arrowhead) and distal loop of the fistula forms a complete loop and finally enters the left coronary sinus
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F4
Cardiac catheterization confirmed the CT findings [Figures 4A and B] with suprasystemic pressure in the right ventricle.