Vitarelli Antonio, De Curtis Guglielmo, Conde Ysabel, Colantonio Mario, Di Benedetto Giulia, Pecce Piero, De Nardo Luigi, Squillaci Ettore
Cardiac Department, La Sapienza University, Rome, Italy.
Am J Med. 2002 Aug 1;113(2):127-33. doi: 10.1016/s0002-9343(02)01157-9.
Coronary angiography is the gold standard for imaging the coronary tree, but the relation of coronary artery fistulas to other structures, and their origin and course, may not be apparent. We evaluated the ability of multiplane color Doppler transesophageal echocardiography to identify coronary fistulas.
Twenty-one patients with angiographically confirmed coronary artery fistulas were investigated by transesophageal echocardiography in four Italian hospitals between January 1997 and May 2001.
Transesophageal echocardiography correctly diagnosed fistulous connection in all 21 patients. This included 6 patients with connections from the left circumflex artery (into the right chambers of the heart in 5 patients, and into the left ventricle in 1 patient), 10 patients with a fistula arising from the left anterior descending artery or left main coronary artery (with drainage into the right ventricle or main pulmonary artery), and 5 patients with a fistula from the right coronary artery (with drainage sites in the lateral aspect of the right ventricle, the low posterior right atrium, or the superior vena cava). In 4 of the 21 patients, angiography did not identify the precise site of a fistula into the coronary sinus or right ventricle.
Color Doppler transesophageal echocardiography is useful in the diagnosis and in the precise localization of coronary artery fistulas.
冠状动脉造影是冠状动脉成像的金标准，但冠状动脉瘘与其他结构的关系及其起源和走行可能并不明显。我们评估了多平面彩色多普勒经食管超声心动图识别冠状动脉瘘的能力。
1997年1月至2001年5月期间，在意大利的四家医院对21例经血管造影证实患有冠状动脉瘘的患者进行了经食管超声心动图检查。
经食管超声心动图正确诊断了所有21例患者的瘘管连接。其中包括6例左回旋支瘘（5例流入心脏右腔，1例流入左心室），10例左前降支或左主干冠状动脉瘘（引流至右心室或主肺动脉），以及5例右冠状动脉瘘（引流至右心室外侧、右心房后壁下部或上腔静脉）。21例患者中有4例血管造影未明确瘘管进入冠状窦或右心室的精确部位。
彩色多普勒经食管超声心动图对冠状动脉瘘的诊断和精确定位很有用。
