Ohayon Paul, Matta Anthony, Boudou Nicolas
Department of Cardiology, Rangueil Hospital, 1 Avenue du Professeur Jean Poulhès, 31400 Toulouse, France.
Cardiology Division, Faculty of Medicine, Holy Spirit University of Kaslik, PO Box 446 Jounieh, Mount Lebanon, Lebanon.
Eur Heart J Case Rep. 2020 May 3;4(3):1-6. doi: 10.1093/ehjcr/ytaa094. eCollection 2020 Jun.
Acquired coronary cameral fistula is an extremely rare condition that involves an abnormal communication between a coronary artery and a cardiac chamber. It usually occurs after chest trauma or cardiovascular interventions, such as percutaneous coronary intervention (PCI) and is associated with various outcomes, ranging from a stable status to haemodynamic instability. Acquired coronary cameral fistula frequently arises from the right coronary artery and drains generally into the right ventricle.
We report the unusual case of a 56-year-old male patient referred to an invasive cardiology centre for a suspected left anterior descending (LAD) coronary-left ventricular (LV) fistula resulting from a primary PCI for an anterior ST-elevation myocardial infarction. Here, the confirmed LAD-LV fistula was successfully treated by retrograde PCI with covered stent implantation. Clinical and angiographic outcomes were favourable at 1-month follow-up.
Coronary cameral fistula can be a severe complication of primary PCI. Various treatment strategies can be considered based on haemodynamic status and anatomical features. In the case described herein, the use of a retrograde approach led to permanent fistula closure and complete revascularization.
后天性冠状动脉心腔瘘是一种极为罕见的病症，涉及冠状动脉与心腔之间的异常连通。它通常发生在胸部创伤或心血管介入术后，如经皮冠状动脉介入治疗（PCI），并与各种后果相关，从稳定状态到血流动力学不稳定。后天性冠状动脉心腔瘘常起源于右冠状动脉，通常引流至右心室。
我们报告了一例不同寻常的病例，一名56岁男性患者因前壁ST段抬高型心肌梗死接受初次PCI后疑似左前降支（LAD）冠状动脉-左心室（LV）瘘，被转诊至一家侵入性心脏病中心。在此，经覆膜支架植入逆行PCI成功治疗了确诊的LAD-LV瘘。1个月随访时临床和血管造影结果良好。
冠状动脉心腔瘘可能是初次PCI的严重并发症。可根据血流动力学状态和解剖特征考虑各种治疗策略。在本文所述病例中，采用逆行方法实现了瘘管永久性闭合和完全血运重建。
