The value of echocardiography combined with CT angiography in the diagnosis of congenital coronary artery fistula
Li Yuhan
Zhu Yuan
Jin Jing
Zhang Dan
Zhang Xuemei
Abstract：Objective To analyze the accuracy of transthoracic echocardiography(TTE)combined with coronary computed tomography angiography(CTA)in the diagnosis of congenital coronary artery fistula(CAF),and to describe its imaging features and discuss the diagnostic value of the two examination methods.Methods A total of 22 patients with coronary artery fistula suspected by TTE in Shaanxi Provincial People's Hospital from 2016 to 2021 were selected by PACS system,and then CTA was performed.Sixteen patients with coronary artery fistula were confirmed by surgery or coronary angiography,and 6 other patients.Multivariate logistic regression analysis was used to plot receiver operating characteristic(ROC)curve analysis to evaluate the performance of the three diagnostic modalities.Results Among 16 patients with coronary artery fistula,1 patient had type I fistula into the right ventricle.Type II fistula into the right atrium in 1 case;Type III fistula into the left ventricle in 3 cases;Type IV fistula into the left atrium in 1 case;V-type fistula into pulmonary artery in 10 cases.Among them,13 cases were confirmed by TTE and 3 cases were missed.CTA was confirmed in 14 cases and missed in 2 cases.15 cases were diagnosed by TTE combined with CTA,and 1 case was missed.All missed diagnoses were left coronary artery-pulmonary artery fistula.Among them,8 cases had multiple fistulas,the inner diameter of the fistulas was 1.0～9.6 mm,and 6 cases formed coronary aneurysms,the larger of which was 117×51 mm.The specificity of TTE combined with CTA in the diagnosis of CAF(83.3%)was higher than that of TTE(50.0%)and CTA(66.7%).The sensitivity of TTE combined with CTA in the diagnosis of CAF(93.7%)was higher than that of TTE(81.3%)and CTA(87.5%).The negative predictive value of TTE combined with CTA in the diagnosis of CAF(83.3%)was higher than that of TTE(50.0%)and CTA(66.7%).Area under ROC TTE(AUC=0.906,95%CI:0.780～1.000),CTA(AUC=0.938,95%CI:0.834～1.000),TTE combined with CTA(AUC=0.969,95%CI:0.895～1.000).The differences were statistically significant(P<0.05).Conclusion The combined use of TTE and CTA improves the diagnostic efficiency of CAF,with type V fistulas being the most common.The findings suggest that transthoracic echocardiography combined with CT angiography has clinical value and should be considered for broader application.
Keywords：Coronary artery fistulaEchocardiographyComputed tomography angiography
Publication Date：2023-08-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：4( 954-957 )