Review
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World J Radiol. May 28, 2014; 6(5): 169-176
Published online May 28, 2014. doi: 10.4329/wjr.v6.i5.169
Unusual fistulas and connections in the cardiovascular system: A pictorial review
Abed Ghandour, Prabhakar Rajiah
Abed Ghandour, Prabhakar Rajiah, Cardiothoracic Imaging Section, Department of Radiology, University Hospitals of Cleveland, Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States
Author contributions: Ghandour A and Rajiah P both contributed in writing and editing the manuscript.
Correspondence to: Prabhakar Rajiah, MD, Cardiothoracic Imaging Section, Department of Radiology, University Hospitals of Cleveland, Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, United States. radprabhakar@gmail.com
Telephone: +1-216-8443112 Fax: +1-216-8445205
Received: January 3, 2014
Revised: March 6, 2014
Accepted: March 13, 2014
Published online: May 28, 2014
Processing time: 145 Days and 11.8 Hours
Abstract

A fistula is an abnormal vascular connection leading to diversion of blood from a high resistance arterial circuit to low resistance venous circuit. Coronary artery fistulas are abnormal communications of the coronary artery with a chamber of the heart, or with any segment of systemic or pulmonary circulation, bypassing the myocardial capillaries. Other unusual fistulas include connection between aorta and the right atrium/superior vena cava, aorta and the inferior vena cava or between a coronary artery bypass graft and a cardiac vein. Abnormal connections also include origin of the coronary artery from the pulmonary artery. In this article, we review the imaging, particularly computed tomography and magnetic resonance imaging of unusual fistulas and connections involving the cardiovascular system, particularly the coronary arteries and the aorta.

Keywords: Coronary; Artery; Fistula

Core tip: Computed tomography and magnetic resonance imaging are very useful imaging modalities in determining the type and demonstrating the anatomy of these fistulas, which is essential for surgical/interventional planning. Careful analysis in multiple planes and three-dimensional reconstruction is required for comprehensive evaluation of fistulas. Treatment depends on the symptoms and the anatomy.