Obana M, Shiono M, Orime Y, Hata H, Yagi S, Sezai Y
Second Department of Surgery, Nihon University School of Medicine, Tokyo, Japan.
Jpn J Thorac Cardiovasc Surg. 1998 Dec;46(12):1349-53. doi: 10.1007/BF03217928.
We encountered a case with bilateral fistulas of coronary arteries into the right atrium, a rare cardiac anomaly. The case was a 17-year-old woman, who visited our hospital at the age of 11 because of fever. At that time, the patient was diagnosed as having a left coronary artery-right atrial fistula through cardiac catheterization (CAG). When the patient developed staphylococcus infected endocarditis at the age of 16, a thick fistula of the coronary artery, directly running from the deformed left coronary arterial sinus, a fistula of the left circumflex branch, and also a fistula of the right coronary artery into the right atrium were detected by CAG. The outlets of these fistulas were closed from the inside of the right atrium under artificial cardiopulmonary circulation and cardiac arrest, and each fistula was ligated at the outside of cardiac chambers. At that time, we took particular care that any branch of the sinuatrial node was not injured. Although all fistulas were confirmed to be closed by postoperative CAG, and no evidence of ischemia was detected by myocardial scintigraphy, deformity of the left coronary arterial sinus remained, requiring further follow up.
我们遇到了一例冠状动脉双侧瘘入右心房的病例，这是一种罕见的心脏异常。该病例为一名17岁女性，11岁时因发热就诊于我院。当时，通过心脏导管检查（CAG）诊断该患者患有左冠状动脉-右心房瘘。患者16岁时发生葡萄球菌感染性心内膜炎，CAG检测发现冠状动脉有粗大瘘管，直接起自变形的左冠状动脉窦，还有左旋支瘘管以及右冠状动脉瘘入右心房。在人工心肺循环和心脏停搏下，从右心房内部封闭这些瘘管的出口，并在心脏腔室外结扎各瘘管。当时，我们特别注意避免损伤窦房结的任何分支。尽管术后CAG证实所有瘘管均已闭合，心肌闪烁显像未检测到缺血证据，但左冠状动脉窦仍有畸形，需要进一步随访。
