Collet F, Bru P, Jouve B, Cointe R, Barragan P, Metge M, Gerard R
Service de cardiologie, centre cardio-vasculaire, Marseille.
Arch Mal Coeur Vaiss. 1990 Feb;83(2):267-70.
The authors report the case of a 23 year old man who presented with a continuous murmur five years after closed chest trauma. The electrocardiographic and echocardiographic findings indicated previous apical myocardial infarction. The underlying diagnosis was first suggested by continuous wave Doppler which showed systolo-diastolic flow in the septo-apical region directed towards the left ventricle (LV) in diastole. Color Doppler flow studies showed a mosaic pattern opposite a dilated left anterior descending (LAD) artery. These signs of LAD-LV fistula with a single orific were confirmed at coronary arteriography. The patient's previous history was in favour of a traumatic etiology. In the absence of left ventricular failure and myocardial ischaemia by coronary steal, surgery was deferred; Doppler echocardiography would seem to be a good method of following up the fistula and its consequences on left ventricular function. A traumatic left coronary to left ventricular fistula is an extremely rare condition and merits publication. The authors review the literature and describe the physiopathology, diagnosis and therapeutic indications of these fistulae.
作者报告了一名23岁男性的病例，该患者在闭合性胸部创伤五年后出现连续性杂音。心电图和超声心动图检查结果提示既往有根尖部心肌梗死。连续波多普勒最初提示了潜在的诊断，该检查显示在舒张期，间隔至心尖区域存在收缩期-舒张期血流，血流指向左心室（LV）。彩色多普勒血流研究显示在扩张的左前降支（LAD）动脉相对处有镶嵌样血流模式。在冠状动脉造影时证实了这些单孔LAD-LV瘘的征象。患者既往史支持创伤性病因。由于没有左心室衰竭和冠状动脉窃血导致的心肌缺血，手术被推迟；多普勒超声心动图似乎是随访瘘管及其对左心室功能影响的良好方法。创伤性左冠状动脉至左心室瘘是一种极其罕见的疾病，值得发表。作者回顾了文献并描述了这些瘘管的病理生理学、诊断和治疗指征。
