Takahashi Shin, Takizawa Yurie, Nakano Satoshi, Koizumi Junichi, Oyama Kotaro
Department of Pediatrics, School of Medicine, Iwate Medical University, Morioka, Japan.
Department of Cardiovascular Surgery, School of Medicine, Iwate Medical University, Morioka, Japan.
Case Rep Cardiol. 2018 May 22;2018:7505283. doi: 10.1155/2018/7505283. eCollection 2018.
The case of a patient in whom hemodynamic and electrocardiographic studies using the occlusion test for coronary artery fistulas (CAF) were safely performed prior to catheter embolization is reported. A 1-year-old girl had a separate right coronary artery arising from a left single coronary artery that formed a significant coronary artery fistula to the right ventricle. Coronary steal by the large coronary artery fistula narrowed the left coronary artery. The right coronary artery branches could not be clearly identified due to an overlap with the fistula. Due to the long porous CAF, embolic procedures could cause serious complications. We confirmed the safety by performing an occlusion test of the CAF's proximal blood vessels. Following total occlusion of the CAF for 10 minutes, pulmonary arterial pressure and aortic blood pressure were not significantly changed. No bradycardia, atrioventricular block, or ST changes were observed. Coil embolization treatment was performed safely. For patients with long distal CAF complicated with a single coronary artery, myocardial ischemia and conduction system disorders can be identified by performing the occlusion test before embolization.
本文报道了一例在导管栓塞术前通过冠状动脉瘘（CAF）闭塞试验安全地进行血流动力学和心电图研究的患者病例。一名1岁女童有一条单独的右冠状动脉，起源于左单冠状动脉，并形成了一个通向右心室的明显冠状动脉瘘。大冠状动脉瘘导致的冠状动脉窃血使左冠状动脉变窄。由于与瘘管重叠，右冠状动脉分支无法清晰识别。由于CAF的多孔性较长，栓塞手术可能会导致严重并发症。我们通过对CAF近端血管进行闭塞试验来确认安全性。在CAF完全闭塞10分钟后，肺动脉压和主动脉血压没有明显变化。未观察到心动过缓、房室传导阻滞或ST段改变。安全地进行了线圈栓塞治疗。对于合并单冠状动脉的远端CAF较长的患者，在栓塞前进行闭塞试验可以识别心肌缺血和传导系统障碍。
