Hashiyama Naoki, Katayama Yusuke, Mo Makoto, Masuda Munetaka
Department of Cardiovascular Surgery, Yokohama Minami Kyousai Hospital, Yokohama, Japan.
Kyobu Geka. 2017 Mar;70(3):181-185.
A 69-year-old woman was referred to our hospital due to dyspnea on exertion and a heart murmur. A chest X-ray showed a bulge at the left 3rd arch and chest computed tomography( CT) revealed a giant mass adjacent to the right ventricular outflow. Multidetector-row CT and coronary angiography showed a giant coronary aneurysm (55×45 mm) and fistulae arising from the left main coronary trunk and entering into the main pulmonary artery (PA). The pulmonary to systemic flow ratio was 1.84. She was diagnosed with coronary-pulmonary artery fistulae with giant coronary aneurysm. Aneurysmorrhaphy and closure of the fistula outlet from the PA were performed under cardiopulmonary bypass with cardiac arrest. After declamping the aorta, residual shunt flow was found at several sites of abnormal vessels in the right ventricular outflow using a Doppler flowmeter. The vessels were ligated with pledgeted sutures, but did not disappear completely. Postoperative coronary angiography and transthoracic echocardiogram showed a small residual shunt flow into the PA. The postoperative course was uneventful;she was discharged on postoperative day 18. Six months later, the residual shunt flow had disappeared. No recurrence has been detected for 7 years.
一名69岁女性因劳力性呼吸困难和心脏杂音转诊至我院。胸部X线显示左第3弓膨出，胸部计算机断层扫描（CT）显示右心室流出道旁有一巨大肿块。多排螺旋CT和冠状动脉造影显示一个巨大的冠状动脉瘤（55×45mm）以及发自左冠状动脉主干并进入主肺动脉（PA）的瘘管。肺循环与体循环血流量之比为1.84。她被诊断为伴有巨大冠状动脉瘤的冠状动脉-肺动脉瘘。在心脏停搏的体外循环下进行了动脉瘤缝合术和肺动脉瘘口闭合术。松开主动脉夹后，使用多普勒流量计在右心室流出道的几个异常血管部位发现了残余分流。用带垫片的缝线结扎这些血管，但分流并未完全消失。术后冠状动脉造影和经胸超声心动图显示仍有少量残余分流进入肺动脉。术后过程顺利；她于术后第18天出院。6个月后，残余分流消失。7年来未检测到复发。
