Smettei Osama Abdalhadi, Abazid Rami Mahmood
Advanced Cardiac Imaging Prince Sultan Cardiac Centre, Qassim, Saudi Arabia.
Avicenna J Med. 2015 Apr-Jun;5(2):49-51. doi: 10.4103/2231-0770.154200.
Coronary artery fistulas (CAFs): Are anomalous connections of the coronary arteries (CA) with major vascular structures or heart chambers. Most of CAFs are incidental findings during invasive coronary angiography (ICA) or computed tomography angiography (CTA). Many patients with CAFs are asymptomatic; only a minority has been associated with various clinical features and outcomes. We have reported a rare CAF complicated with acute myocardial infarction (AMI) in 43 years old female Patient who was admitted to our institution with a Diagnosis of Acute Infero-Posterior Myocardial Infarction (AMI). ICA and CTA showed a thrombosed CAF between left main coronary artery and right atrium with totally occluded left circumflex artery by a thrombus extended from the fistula. As there was a high risk associated with immediate intervention, the patient was kept on conservative management with a future plan of catheter-assisted or surgical closure. We have shown a rare case of CAF presenting with AMI that is unusual for such an anomaly, and have highlighted the role of CTA in the diagnosis and management of such rare disorder.
冠状动脉瘘（CAFs）：是冠状动脉（CA）与主要血管结构或心腔的异常连接。大多数冠状动脉瘘是在有创冠状动脉造影（ICA）或计算机断层血管造影（CTA）期间偶然发现的。许多患有冠状动脉瘘的患者没有症状；只有少数患者与各种临床特征和预后相关。我们报道了一例罕见的冠状动脉瘘合并急性心肌梗死（AMI）的病例，该43岁女性患者因急性下后壁心肌梗死（AMI）诊断入院。ICA和CTA显示左冠状动脉主干与右心房之间有一个血栓形成的冠状动脉瘘，左旋支动脉被从瘘管延伸而来的血栓完全阻塞。由于立即干预存在高风险，患者接受保守治疗，并计划未来进行导管辅助或手术闭合。我们展示了一例罕见的以急性心肌梗死为表现的冠状动脉瘘病例，这种异常情况并不常见，并强调了CTA在诊断和管理这种罕见疾病中的作用。
