Testuz Ariane, Roffi Marco, Bonvini Robert Francis
Cardiology Division, University Hospital, Geneva, Switzerland.
J Invasive Cardiol. 2011 Jul;23(7):E177-80.
We report the incidental finding of 2 coronary to pulmonary artery fistulas observed at coronary angiography performed in a 48-year-old man presenting with acute inferior ST-elevation myocardial infarction (STEMI). Coronary angiography revealed an acute thrombotic occlusion of the mid segment of the right coronary artery (RCA), which was treated with thromboaspiration and bare-metal stenting. Significant stenoses of the left anterior descending (LAD) and left circumflex (LCX) arteries were also observed during angiography, as well as the presence of 2 large coronary to pulmonary artery fistulas, one originating from the proximal LAD and the other from the ostial RCA. The clinical evolution was uneventful and the patient underwent successful coronary bypass grafting of the LAD and LCX lesions associated with ligation of the coronary artery fistulas 6 weeks later. The fact that 2 large coronary to pulmonary artery fistulas were observed during an acute coronary syndrome in a previously asymptomatic patient with extensive coronary artery disease is of particular interest, because it allowed early surgical correction of this rare inborn coronary anomaly before the development of late and irreversible left ventricular dysfunction.
我们报告了在一名48岁急性下壁ST段抬高型心肌梗死（STEMI）男性患者进行冠状动脉造影时偶然发现的2例冠状动脉至肺动脉瘘。冠状动脉造影显示右冠状动脉（RCA）中段急性血栓闭塞，经血栓抽吸和裸金属支架置入治疗。血管造影期间还观察到左前降支（LAD）和左旋支（LCX）动脉有明显狭窄，以及2个大的冠状动脉至肺动脉瘘，一个起源于LAD近端，另一个起源于RCA开口处。临床病程平稳，患者在6周后成功接受了与冠状动脉瘘结扎相关的LAD和LCX病变的冠状动脉搭桥术。在一名先前无症状但患有广泛冠状动脉疾病的患者的急性冠状动脉综合征期间观察到2个大的冠状动脉至肺动脉瘘，这一事实特别令人感兴趣，因为它使得在晚期和不可逆的左心室功能障碍发生之前，能够对这种罕见的先天性冠状动脉异常进行早期手术矫正。
