Stojišić-Milosavljević Anastazija, Bikicki Miroslav, Ivanović Vladimir, Šobot Nikola, Popin Tijana Momčilov, Kovačević Dragan
Srp Arh Celok Lek. 2015 Sep-Oct;143(9-10):609-14. doi: 10.2298/sarh1510609s.
Bilateral coronary artery fistulae to pulmonary artery with ventricular tachycardia have not yet been described in the literature.
A case of a 23-year-old male patient who was treated at our clinic for recurrent ventricular tachycardia is presented. The patient was born with six fingers on his left hand, which was surgically corrected in his early childhood. Perfusion scintigraphy demonstrated reversible ischemia at the irrigation zone of the right coronary artery. The coronary angiography revealed two coronary to pulmonary artery fistulae. The right coronary artery fistula drained through a tubular vessel formation into the pulmonary artery, but the left anterior descendent fistula drained via multiple thin tortuous vessels into the pulmonary artery. The right coronary artery fistula was ligated surgically. The control scintigraphy registered no perfusion defect subsequently, but during the procedure ventricular tachycardia occurred. An electrophysiology study followed, but ventricular tachycardia could not be provoked. Two months later ventricular tachycardia occurred again. Two subsequent electrophysiology studies showed no ventricular tachycardia.The patient was treated with an implantable cardioverter defibrillator.Ventricular tachycardia was terminated four times during the first year follow-up.
The mechanism of the ventricular tachycardia was unclear.The electrophysiology study was not sufficiently reliable in the patient with recurrent ventricular tachycardia and bilateral coronary artery to pulmonary artery fistulae. The therapy of choice and the prevention of sudden death in this case was an implantable cardioverter defibrillator.
双侧冠状动脉瘘合并室性心动过速尚未见文献报道。
本文介绍了一名23岁男性患者，因反复室性心动过速在我院接受治疗。该患者出生时左手有六指，幼儿期接受了手术矫正。灌注闪烁显像显示右冠状动脉灌注区存在可逆性缺血。冠状动脉造影显示两条冠状动脉至肺动脉瘘。右冠状动脉瘘通过管状血管形成引流至肺动脉，而左前降支瘘则通过多条细小迂曲血管引流至肺动脉。右冠状动脉瘘进行了手术结扎。随后的对照闪烁显像未发现灌注缺损，但手术过程中发生了室性心动过速。接着进行了电生理检查，但未能诱发室性心动过速。两个月后室性心动过速再次发作。随后的两次电生理检查均未发现室性心动过速。该患者接受了植入式心脏复律除颤器治疗。在第一年随访期间，室性心动过速终止了四次。
室性心动过速的机制尚不清楚。对于反复室性心动过速且合并双侧冠状动脉至肺动脉瘘的患者，电生理检查不够可靠。在这种情况下，首选的治疗方法和预防猝死的措施是植入式心脏复律除颤器。
