Ren Yan, Xie Lin, Ruan Weiqiang, Li Yajiao, Ji Peng, Gan Changping, Lin Ke
Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China.
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
BMC Surg. 2019 Nov 8;19(1):166. doi: 10.1186/s12893-019-0624-3.
Coronary artery aneurysms in most cases require surgical treatment once diagnosed. Lifelong anticoagulation is often needed after surgery. We herein describe a 55-year-old man who was asymptomatic and diagnosed with right giant coronary artery aneurysm combined with right atrial fistula.
This is a case of asymptomatic giant right coronary artery aneurysm concurrent with coronary artery fistula. Because the aneurysm was in the distal right posterior descending coronary artery, right coronary artery ligation and fistula occlusion through the right atrium were performed in the absence of cardiopulmonary bypass. The aneurysm was excluded without impacting the myocardial blood supply, and the patient was exempted from lifelong anticoagulation regimen. The follow-up revealed favorable outcomes and the patient's life expectancy was improved.
Decompression and exclusion without cardiopulmonary bypass can be adopted for distal coronary artery aneurysms that do not involve or only have a limited impact on distal blood supply. This procedure can exempt the patient from the lifelong anticoagulation regimen. In addition, the risk for myocardial ischemia caused by the thrombus in the aneurysm can also be avoided. The whole procedure is comparatively easy to perform.
大多数情况下，冠状动脉瘤一旦确诊就需要手术治疗。术后通常需要终身抗凝。我们在此描述一名55岁无症状男性，被诊断为右冠状动脉巨大动脉瘤合并右心房瘘。
这是一例无症状的右冠状动脉巨大动脉瘤并发冠状动脉瘘的病例。由于动脉瘤位于右冠状动脉后降支远端，在非体外循环下行右冠状动脉结扎及经右心房瘘口封堵术。动脉瘤被排除，未影响心肌血供，患者无需终身抗凝治疗。随访结果良好，患者预期寿命得到改善。
对于不涉及或仅对远端血供有有限影响的远端冠状动脉瘤，可采用非体外循环下减压及排除术。该手术可使患者免于终身抗凝治疗。此外，还可避免动脉瘤内血栓引起心肌缺血的风险。整个手术操作相对简单。
