Verneyre H, Lamaud M, Faure F, Michaud P
Arch Mal Coeur Vaiss. 1979 Dec;72(12):1352-8.
The case of a 24-year old patient having suffered a bullet wound was reported. After a hemopericardium accompanied by minor signs of tamponade, a continuous murmur gradually appeared due to a fistula between the right coronary artery and the right atrium, which was strictly symptomless: surgical repair was performed eight years after the accident. This satisfactory spontaneous outcome, after surviving the life threatening danger of tamponade and myocardial infarction was also observed in the 21 cases of coronary-cardiac fistulae already published. The fistula, which almost always involves the right heart cavities, only gives rise to a continuous murmur which is often discovered at a later stage. The long term course of traumatic coronary-cardiac fistulae can only be assessed by comparison with congenital coronary-cardiac fistulae, which are much better known, and the consequences of which are on all accounts similar. Four complications are discussed: heart failure, coronary insufficiency, infectious endocarditis, and the rupture of the fistulized coronary artery due to aneurysmal dilatation. These risks are statistically small and more theoretical then real, and the justification of systematic repair of traumatic coronary-cardiac fistulae now rests essentially on the relatively low risk of the procedure.
报道了一例24岁的枪伤患者。在出现伴有轻微心包填塞体征的血心包后，由于右冠状动脉与右心房之间形成瘘管，逐渐出现连续性杂音，且该瘘管完全没有症状：事故发生八年后进行了手术修复。在已发表的21例冠状-心内瘘病例中，也观察到在成功度过危及生命的心包填塞和心肌梗死危险后出现这种令人满意的自发转归情况。瘘管几乎总是累及右心腔，仅产生连续性杂音，且常常在后期才被发现。创伤性冠状-心内瘘的长期病程只能通过与更为人熟知的先天性冠状-心内瘘进行比较来评估，二者在各方面的后果相似。文中讨论了四种并发症：心力衰竭、冠状动脉供血不足、感染性心内膜炎以及因动脉瘤样扩张导致的瘘化冠状动脉破裂。这些风险在统计学上较小，更多是理论上的而非实际存在的，目前对创伤性冠状-心内瘘进行系统性修复的理由主要基于该手术相对较低的风险。
