Ayşe EMRE, Sinan ŞAHİN, Demet DOĞAN, Hasan ŞAHAN, Seviye Bora ŞİŞMAN

Koroner arter fistüllerinin tanısında çok kesitli bilgisayarlı tomografinin yeri

Amaç: Bu çalışmada çeşitli nedenlerle çok kesitli bilgisayarlı tomografik anjiyografi incelemesi yapılan hastalarda koroner arter fistüllerinin sıklığı ile anatomik özellikleri araştırıldı. Çalışma planı: Ocak 2009 - Temmuz 2015 tarihleri arasında kliniğimizde çok kesitli bilgisayarlı tomografik anjiyografi kullanılarak 26 hastada toplam 40 adet koroner arter fistülü retrospektif olarak incelendi. Etkilenen arterler ve fistüllerin yerleşim yerleri değerlendirildi. Bulgular: Fistüllerin 11’i (%27.5) sirkümfleks arterden, 10’u (%25) sol ön inen arterden, dördü (%10) diagonal arterden, üçü (%7.5) sol ana koroner arterden, üçü (%7.5) sağ ana koroner arterden, üçü (%7.5) septal arterden, üçü (%7.5) konus arterinden, biri (%2.5) obtus marjinal arterden, biri (%2.5) sol ön inen arter properden (dual LAD) ve biri (%2.5) ramus intermediustan köken almaktaydı. Konus arterlerinden biri doğrudan sağ koroner sinüsten köken almaktaydı. Fistüllerden 12’si (%30) pulmoner trunkusa, sekizi (%20) sol ventriküle, yedisi (%17.5) sağ ventriküle, beşi (%12.5) superior vena kavaya, üçü (%7.5) sağ ana pulmoner artere, ikisi (%5) sağ atriyuma, biri (%2.5) sol atriyuma, biri (%2.5) sağ internal torasik artere ve biri de (%2.5) sinüs koronariusa açılmaktaydı. Sonuç: Konvansiyonel anjiyografiye kıyasla, çok kesitli bilgisayarlı tomografi anjiyografi koroner arter fistüllerinin daha yüksek oranda tespit edilebilmesine ve kalp anatomisinin ayrıntılı bir şekilde görüntülenebilmesine olanak sağlayan invaziv olmayan bir yöntemdir.

The role of multislice computed tomography in the diagnosis of coronary artery fistulas

Background: This study aims to investigate the frequency and the anatomical features of coronary artery fistulas in patients undergoing multislice computed tomographic angiography for various reasons. Methods: Between January 2009 and July 2015, a total of 40 coronary artery fistulas of 26 patients were retrospectively analyzed using multislice computed tomographic angiography in our clinic. The affected arteries and localizations of the fistulas were evaluated.Results: Of the fistulas, 11 (27.5%) were originating from the circumflex artery, 10 (25%) from the left anterior descending artery, four (10%) from the diagonal arteries, three (7.5%) from the left main coronary artery, three (7.5%) from the right main coronary artery, three (7.5%) from the septal artery, three (7.5%) from the conus artery, one (2.5%) from the obtuse marginal artery, one (2.5%) from left anterior descending artery proper (dual LAD), and one (2.5%) from the ramus intermedius. One of the conus arteries was directly originating from the right coronary sinus. Twelve (30%) of the fistulas were draining into the pulmonary trunk, eight (20%) into the left ventricle, seven (17.5%) into the right ventricle, five (12.5%) into the superior vena cava, three (7.5%) into the right main pulmonary artery, two (5%) into the right atrium, one (2.5%) into the left atrium, one (2.5%) into the right internal thoracic artery, and one (2.5%) into the sinus coronarius.Conclusion: Compared to conventional angiography, multislice computed tomographic angiography is a non-invasive modality which allows enhancing coronary artery fistulas at a higher rate and visualizing the cardiac anatomy in detail.

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