Padrões de trajeto de fístulas coronarianas com ou sem cardiopatia congênita: análises epidemiológica, ecocardiográfica e computacional

Abstract

Coronary artery fistula (CAF) is a direct connection of one or more coronary arteries to cardiac chambers or a large vessel. It prevails in 0.002% of the population and in 0.4% of cardiac malformations. Objective: Due to its rarity and the potential clinical and surgical contribution of its morphological characterization, the present study aims to establish CAF path patterns from echocardiographic and computational data. Methodology: After ethical approval, 7.183 electronic medical records of children (cardiac or noncardiac disease patients) were submitted to two-dimensional color Doppler echocardiography (Philips Healthcare® HD 11 and HD 15 model) according to American Society of Echocardiography guidelines. Epidemiological variables considered included age, sex and associated or non-associated heart disease. Morphological variable considered to evaluate possible path pattern of FAC described in echocardiographic reports for three-dimensional reconstruction by Cinema 4DR19 software for modeling, texturing and animation. Statistical analysis included descriptive evaluation and Linear Regression, Kruskal Wallis and Spearman Correlation tests, with a significance level of 5%. Results: Epidemiology of CAF evidenced more affected age group up to 180 days of life (46.15%); male or female (50% each); and presence of another heart disease in 96.15% of the cases. There was no significant statistical evidence for CAF. Of the 7.183 medical files considered, 26 cases (0.0036%) presented visible AF on echocardiographic examination: of the right coronary artery (RCA) for right ventricle (RV) (26.92%), left coronary artery (LCA) for RV (23.08%), anterior interventricular branch (AIB) for RV (23.08% ), from RCA to right atrium (11.54%), LCA to pulmonary trunk (PT) (7.69%) and AIB to PT (7.69%). Conclusion: CAF is an unusual anatomical entity, tends to affect children in the first six months of life, with a similar prevalence between the sexes. Echocardiogram is the initial choice exam for CAF diagnosis due to its appropriate cost-effectiveness, non-invasiveness, portability and high potential for morphological and cardiac hemodynamic investigations. In echocardiographic analyzes, right, left or anterior interventricular branch fistulas represent about one third of the cases each, with priority drainage for right heart chambers. Because of its rarity, three-dimensional computational representation of CAF contributes to better imaging understanding, therefore, it can aid at the surgical planning.