Gürbüz Ali, Yetkin Ufuk, Tetik Omer, Kestelli Mert, Yesil Murat
Izmir Atatürk Education and Research Hospital, Department of Cardiovascular Surgery, Izmir, Turkey.
Heart Surg Forum. 2007;10(4):E325-8. doi: 10.1532/HSF98.20071002.
Coronary artery fistula (CAF) is a rare congenital anomaly of the coronary arteries in which abnormal connections are present between the coronary artery branch and the cardiac chambers or a major vessel. The incidence of CAF is estimated at 1 in 50,000 live births, and it is detected in approximately 0.2% of the adult population during coronary angiography. Reports of the coincidence of mitral stenosis and CAF are rare in the literature. We report a case of CAF and mitral valve stenosis in a patient with dyspnea and fatigue before valve replacement and surgical radiofrequency ablation. Coronary angiography showed a connection between the right coronary artery and right atrium. A fistula opening into the right atrium is rare in patients with coronary artery anomalies and mitral valve disease. Coronary angiography of the patient 1 month after surgical repair showed that the coronary anatomy was normal and the fistula was occluded. CAF can be diagnosed more frequently if coronary angiography is performed simultaneously with cardiac catheterization to evaluate valve functions or nonatherosclerotic myocardial ischemia in each valvular heart disease case. Surgical repair of CAF is the first-choice treatment to prevent complications and improve quality of life.
冠状动脉瘘（CAF）是一种罕见的冠状动脉先天性异常，其冠状动脉分支与心腔或大血管之间存在异常连接。CAF的发病率估计为每50000例活产中有1例，在冠状动脉造影检查中，约0.2%的成年人群中可检测到。二尖瓣狭窄与CAF并存的报道在文献中很少见。我们报告1例在进行瓣膜置换和手术射频消融术前出现呼吸困难和疲劳的CAF合并二尖瓣狭窄患者。冠状动脉造影显示右冠状动脉与右心房之间存在连接。在冠状动脉异常和二尖瓣疾病患者中，瘘口通向右心房的情况很少见。手术修复1个月后患者的冠状动脉造影显示冠状动脉解剖结构正常，瘘管已闭塞。如果在评估各瓣膜性心脏病病例的瓣膜功能或非动脉粥样硬化性心肌缺血时，同时进行冠状动脉造影和心导管检查，CAF可能会被更频繁地诊断出来。CAF的手术修复是预防并发症和提高生活质量的首选治疗方法。
