Jha Neerod Kumar, Kiraly Laszlo, Shah Nishant, Al Mulla Arif, Mora Bassem
Institute of Cardiac Sciences, PO BOX 51900, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
J Cardiothorac Surg. 2019 Feb 8;14(1):33. doi: 10.1186/s13019-019-0854-6.
Congenital coronary artery fistula in association with aneurysm of the involved coronary artery in adults is rare. Moreover, the right coronary artery- left atrial fistula is also uncommon. Most of the cases are asymptomatic. However, symptomatic patients need therapeutic interventions. The potential complications associated with this anomaly are life-threatening, therefore, there is a need to explore more on differential diagnosis, investigations, management strategies and prevention of complications.
We present herewith a 26-year-old male patient with symptoms of chest pain and dyspnea. He was diagnosed with aneurysmal dilatation of the right coronary artery in its entire course which terminated as a fistulous communication into the left atrium. The closure of the fistula was done using autologous pericardial patch under cardiopulmonary bypass. Currently, the patient is being followed up after surgery and receiving anticoagulants.
The advancement in the diagnostic imaging modalities have made it possible to find similar abnormalities more frequently. Due to rare nature of this anomaly, there is a need to explore and discuss management strategies that include medical management, surgical intervention or percutaneous interventions for a successful outcome.
成人先天性冠状动脉瘘合并受累冠状动脉瘤较为罕见。此外，右冠状动脉-左心房瘘也不常见。大多数病例无症状。然而，有症状的患者需要进行治疗干预。与这种异常相关的潜在并发症危及生命，因此，有必要进一步探讨其鉴别诊断、检查、管理策略及并发症的预防。
我们在此报告一名26岁男性患者，有胸痛和呼吸困难症状。他被诊断为右冠状动脉全程瘤样扩张，最终以瘘管形式与左心房相通。在体外循环下使用自体心包补片封闭瘘管。目前，患者术后正在接受随访并服用抗凝剂。
诊断成像方式的进步使得更频繁地发现类似异常成为可能。由于这种异常较为罕见，有必要探索和讨论包括药物治疗、手术干预或经皮干预在内的管理策略，以获得成功的治疗效果。
