Ilhan Erkan, Sahin Sinan, Celebi Ahmet
Meclis Mahallesi Teraziler Caddesi Sarıbelde Sitesi U7A blok daire: 3 34785 Sancaktepe Istanbul, Türkiye.
J Invasive Cardiol. 2011 Feb;23(2):E12-4.
A 54-year-old man was transferred to our emergency department because of acute inferior myocardial infarction. However, ST-segment elevation resolved after intravenous nitrate administration on admission and coronary angiography revealed a nonobstructive atherosclerotic plaque at the mid-portion of the circumflex artery and a giant tortuous fistula from the right sinus of Valsalva to the superior vena cava. The patient was diagnosed with variant angina and coronary arteriovenous fistula after vasodilator treatment and maximal treadmill stress test. After effective medical treatment of variant angina and successful percutaneous coil embolization of the fistula, the patient had not experienced any angina episodes for 1 year. However, control coronary angiography revealed partial persistence of fistula flow because of new collateral vessels, bridging distal and proximal parts of the occluded segment. We present the first coexistence of coronary to superior vena cava fistula and variant angina in the literature. This report also shows the ability of coronary fistulas to develop collateral vessels, like coronary arteries.
一名54岁男性因急性下壁心肌梗死被转至我院急诊科。然而，入院时静脉给予硝酸酯后ST段抬高消失，冠状动脉造影显示回旋支动脉中段有一非阻塞性动脉粥样硬化斑块，以及一个从主动脉瓣窦至右上腔静脉的巨大迂曲瘘管。经血管扩张剂治疗及最大运动平板负荷试验后，该患者被诊断为变异型心绞痛和冠状动脉动静脉瘘。在对变异型心绞痛进行有效药物治疗并成功经皮线圈栓塞瘘管后，患者1年内未再发生心绞痛发作。然而，冠状动脉造影复查显示，由于新的侧支血管形成，桥接了闭塞段的远端和近端，瘘管仍有部分血流持续存在。我们报道了文献中首例冠状动脉至右上腔静脉瘘与变异型心绞痛并存的病例。本报告还显示了冠状动脉瘘形成侧支血管的能力，类似于冠状动脉。
