Jamil Gohar, Khan Asad, Malik Azhar, Qureshi Anwer
Department of Medicine, Division of Cardiology, Tawam Hospital, Al Ain, United Arab Emirates.
BMJ Case Rep. 2013 Jun 3;2013:bcr2013008649. doi: 10.1136/bcr-2013-008649.
A 26-year-old asymptomatic man, being medically managed for ventricular septal defect since childhood, presented to the outpatient clinic for a second opinion. Clinically, he was well built with normal vital signs. Cardiac auscultation was significant for a diastolic murmur over the praecordium. An ECG showed non-specific ST changes, and a subsequent transthoracic echocardiography performed revealed diastolic flow from the left ventricular (LV) anteroseptal wall into the LV cavity. A diagnosis of coronary-cameral fistula was confirmed by a multidetector CT which showed a 2.5×2 cm aneurysmal left anterior descending artery fistula to the LV. In addition to starting aspirin, transcatheter closure with occlusion device was considered knowing the potential risk of thrombus formation in the aneurysm and subsequent systemic embolisation. The patient however refused any percutaneous or surgical intervention. He remains asymptomatic 1 year after returning to his home country.
一名26岁无症状男性，自童年起因室间隔缺损接受内科治疗，现到门诊寻求第二种意见。临床检查发现，他体格良好，生命体征正常。心脏听诊显示心前区有舒张期杂音。心电图显示非特异性ST段改变，随后进行的经胸超声心动图检查显示有舒张期血流从左心室前间隔壁流入左心室腔。多层螺旋CT证实了冠状动脉-心腔瘘的诊断，该检查显示左前降支动脉有一个2.5×2厘米的动脉瘤瘘管通向左心室。考虑到动脉瘤内血栓形成及随后全身栓塞的潜在风险，除开始使用阿司匹林外，还考虑用封堵装置进行经导管封堵。然而，患者拒绝任何经皮或手术干预。回国1年后，他仍无症状。
