Wang Fang, Cranston-D'Amato Hope, Pearson Anthony
Department of Internal Medicine, St. Luke's Hospital, Chesterfield, Missouri.
Department of Critical Care and Infectious Disease, St. Luke's Hospital, Chesterfield, Missouri.
Echocardiography. 2015 Dec;32(12):1868-72. doi: 10.1111/echo.13041. Epub 2015 Sep 6.
Coronary artery fistulae (CAF) are rare congenital anomalies and reported to have an incidence of 0.1-0.2% of all coronary angiograms. An association between fistulae and nonatherosclerotic coronary artery aneurysms is even more rare. In childhood, patients are mostly asymptomatic; however, patients older than 20 years old may present with signs of infective endocarditis, myocardial ischemia, congestive heart failure, and aneurysm rupture. CAF are typically identified by coronary angiography; however, there are some limited studies showing that transesophageal echocardiography (TEE) can also be useful in identifying CAF. Here we report two cases of endocarditis secondary to congenital coronary artery fistulae draining into either a cardiac cavity or a coronary sinus, which were detected by TEE. Vegetations were found at the site of the fistulae drainage. Management for young patients is either percutaneous or surgical intervention. For elderly patients with multiple comorbidities, conservative treatment is another option. In these two cases, treating endocarditis with proper antibiotics and supportive treatment, the patients' conditions improved significantly.
冠状动脉瘘（CAF）是一种罕见的先天性异常，据报道在所有冠状动脉造影中发生率为0.1%-0.2%。瘘与非动脉粥样硬化性冠状动脉瘤之间的关联更为罕见。在儿童期，患者大多无症状；然而，20岁以上的患者可能会出现感染性心内膜炎、心肌缺血、充血性心力衰竭和动脉瘤破裂的症状。CAF通常通过冠状动脉造影来识别；然而，有一些有限的研究表明，经食管超声心动图（TEE）在识别CAF方面也可能有用。在此，我们报告两例先天性冠状动脉瘘导致的心内膜炎病例，瘘分别引流至心腔或冠状窦，通过TEE检测到。在瘘引流部位发现了赘生物。年轻患者的治疗方法是经皮或手术干预。对于有多种合并症的老年患者，保守治疗是另一种选择。在这两例病例中，通过使用适当的抗生素治疗心内膜炎并给予支持治疗，患者的病情显著改善。
