Introduction
CAFs can be defined as an uncommon abnormal connection between coronary arteries and either heart chambers or major thoracic vessels, allowing blood to bypass the usual capillary network in the myocardium. If these connections terminate in heart chambers, they are termed coronary-cameral fistulas, whereas those ending in veins are referred to as coronary arteriovenous fistulas. Congenital forms of CAF are more frequent, but still only make up just 0.4% of all congenital cardiac abnormalities. (1) The majority of patients have a solitary CAF, however, approximately 20% of patients exhibit fistulas originating from two or more coronary arteries. (2).
The clinical presentation of CAFs varies according to factors such as the patient’s age, flow volume, the recipient chamber’s resistance, and the development of myocardial ischemia. Often, the anomaly is inadvertently discovered during routine examinations or coronary angiography, with the condition being recognized due to the presence of a continuous murmur upon examination. (3,4)
Compared to other imaging modalities, computed tomography angiography (CTA) is highly valuable for the assessment of CAFs due to a shorter acquisition time and the ability to provide superior temporal and spatial resolution. Multiplanar reconstruction along with 3D volume-rendered imaging offers exceptional anatomical details, encompassing the origin, trajectory, and drainage location of CAFs. This holds true even for intricate anomalies, thereby establishing its potential as an essential tool for guiding treatment planning. (5)
Regarding treatment, surgical or catheter-based closure is highly recommended for symptomatic patients and asymptomatic patients with high flow shunting, particularly in pediatric cases. Interventional closure has become the preferred approach, especially in younger patients, although the method choice also considers fistula anatomy, presence of other cardiac defects, and the expertise of the interventional cardiologist. (6)