Kim Chang-Yeon, Choi Ji Yong, Kim Kee Sik
Division of Cardiology, Daegu Catholic University Medical Center, Daegu, Korea.
Medicine (Baltimore). 2017 Nov;96(45):e8546. doi: 10.1097/MD.0000000000008546.
Cases of coronary artery fistula having a connection with the cardiac cavity are rare. Here, we report a case in which 2 coronary arteries empty into the left ventricular cavity together.
A 63-year-old woman who was diagnosed as having hypertension 20 years prior presented with dyspnea.
The coronary angiography revealed coronary artery fistula.
Chest X-ray showed pulmonary edema. Transthoracic echocardiography revealed moderately decreased left ventricular (LV) function and increased LV end-diastolic volume and mass index. Coronary angiography and cardiac computed tomography revealed that 2 coronary arteries joined together at the distal end and directly drained into the left ventricular cavity bypassing the myocardial capillary vessels. We started medical treatment for heart failure with an angiotensin-converting-enzyme inhibitor, loop diuretic, and spironolactone.
The pulmonary edema improved rapidly. The patient did not experience dyspnea after discharge, and follow-up echocardiography showed improved cardiac function.
Coronary artery fistula could be found incidentally on coronary angiography performed for varied reasons. Physicians must decide carefully whether the fistula needs to be treated in view of the clinical context.
冠状动脉瘘与心腔相连的病例罕见。在此，我们报告一例两条冠状动脉共同汇入左心室腔的病例。
一名63岁女性，20年前被诊断为高血压，现出现呼吸困难。
冠状动脉造影显示冠状动脉瘘。
胸部X线显示肺水肿。经胸超声心动图显示左心室（LV）功能中度下降，左心室舒张末期容积和质量指数增加。冠状动脉造影和心脏计算机断层扫描显示，两条冠状动脉在远端汇合，绕过心肌毛细血管直接汇入左心室腔。我们开始使用血管紧张素转换酶抑制剂、袢利尿剂和螺内酯进行心力衰竭的药物治疗。
肺水肿迅速改善。患者出院后未再出现呼吸困难，随访超声心动图显示心功能改善。
冠状动脉瘘可能在因各种原因进行的冠状动脉造影中偶然发现。医生必须根据临床情况仔细决定是否需要治疗该瘘。
