Iglesias Juan F, Thai Hoa Tran, Kabir Tito, Roguelov Christan, Eeckhout Eric
Service of Cardiology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, Lausanne, Switzerland.
J Invasive Cardiol. 2010 Mar;22(3):142-5.
Coronary artery fistulae represent the most frequent congenital anomalies of the coronary arteries, but remain a relatively uncommon clinical problem. Moreover, multiple fistulae originating from both the left and the right coronary arteries and draining into the left ventricular chamber are a rare condition. Due to the low prevalence of these anomalies, the appropriate management of patients with symptomatic coronary artery fistulae is controversial. Transcatheter closure approaches have emerged as a less invasive strategy and are nowadays considered a valuable alternative to surgical correction with similar effectiveness, morbidity and mortality. The percutaneous management, however, is mainly limited by the individual anatomic features of the fistula and an appropriate patient's selection is considered as a key determining factor to achieve complete occlusion. Thus, success rates of transcatheter closure techniques reported in the literature are extremely variable and highly dependent upon the nature of the follow up, which, at present, is not standardized. The optimal management of symptomatic patients with multiple coronary artery fistulae still remains a challenging problem and has been traditionally considered as an indication for cardiac surgery. We report here the case of a patient with double bilateral congenital coronary artery fistulae arising from both the left and right coronary arteries and draining individually into the left ventricular chamber. This patient underwent successful transcatheter anterograde closure of both fistulae using a microcoil embolization technique.
冠状动脉瘘是最常见的冠状动脉先天性异常，但仍是相对少见的临床问题。此外，起源于左、右冠状动脉并引流至左心室的多发瘘极为罕见。由于这些异常的发生率较低，有症状的冠状动脉瘘患者的恰当治疗存在争议。经导管封堵方法已成为一种侵入性较小的策略，如今被认为是与外科矫正效果、发病率和死亡率相似的有价值替代方法。然而，经皮治疗主要受瘘的个体解剖特征限制，合适的患者选择被视为实现完全封堵的关键决定因素。因此，文献报道的经导管封堵技术成功率差异极大，且高度依赖随访性质，而目前随访并不规范。有症状的多发冠状动脉瘘患者的最佳治疗仍然是一个具有挑战性的问题，传统上一直被视为心脏手术的指征。我们在此报告一例患者，其双侧先天性冠状动脉瘘分别起源于左、右冠状动脉，并分别引流至左心室。该患者使用微线圈栓塞技术成功进行了经导管顺行封堵双侧瘘。
