Collins Nicholas, Benson Lee N, Horlick Eric M
Toronto Congenital Cardiac Centre for Adults, Department of Cardiology, University Health Network/Toronto General Hospital, Toronto, Ontario, Canada.
Congenit Heart Dis. 2012 Jan-Feb;7(1):80-3. doi: 10.1111/j.1747-0803.2011.00527.x. Epub 2011 Jun 27.
Coronary artery fistulae are an uncommon anomaly and, while frequently asymptomatic, may require interventional therapy. Transcatheter approaches for closure of coronary artery fistulae are now commonly used, with various methods of fistula occlusion described, including detachable coils. During a percutaneous procedure to occlude a symptomatic left anterior descending coronary artery to pulmonary artery fistula, the patient experienced chest discomfort with anterior ST segment elevation. We demonstrate an unusual, unique and striking ECG abnormality complicating the delivery of coils designed to occlude the fistula in the absence of coronary artery injury. The mechanisms of the procedural ECG changes are discussed, as are potential alternate diagnoses and associated therapy.
冠状动脉瘘是一种罕见的异常情况，虽然通常无症状，但可能需要介入治疗。经导管封堵冠状动脉瘘的方法目前已普遍应用，有多种瘘管闭塞方法被描述，包括可脱卸线圈。在经皮封堵有症状的左前降支冠状动脉至肺动脉瘘的过程中，患者出现胸部不适伴前壁ST段抬高。我们展示了一种不寻常、独特且显著的心电图异常，这种异常在没有冠状动脉损伤的情况下，使旨在封堵瘘管的线圈输送过程变得复杂。文中讨论了操作过程中心电图变化的机制，以及潜在的其他诊断和相关治疗方法。
