Right coronary artery-to-right ventricle fistula in a pediatric patient evaluated by 64-detector-row computed tomographic coronary angiography.

A 2-year-old girl in whom a cardiac murmur had been detected at the age of 4 months underwent physical examination. She had no cyanosis, but a continuous murmur was detected. The murmur was centered in the 4th right intercostal space and radiated vertically. The echocardiogram showed right coronary artery (RCA) dilation. We sedated the patient and obtained computed tomographic (CT) images by use of contrast-enhanced electrocardiographic-gated multidetector computed tomographic (MDCT) angiography. A 64-slice CT scanner (Siemens Sensation 64; Erlangen, Germany) (120 kV, 35 mA) was used, with a detector configuration of 64  0.6 mm and a reconstruction interval of 0.6  0.4 mm. We administered 2 mL/kg of nonionic iodinated contrast medium at 2 mL/sec through the antecubital vein; a threshold of 100 Houns field units was used to trigger the diagnostic image acquisition. The scan time was 3.4 seconds, with an effective radiation dose of 1.3 mSv. The MDCT coronary angiograms showed RCA dilation with a fistula to the posterobasal region of the right ventricle (RV) (Figs. 1–3). The fistula was closed successfully with an intraluminal occlusion device (AMPLATZER Duct Occluder, AGA Medical Corporation; Plymouth, Minn), as shown on invasive coronary angiograms (Figs. 4 and 5).