Uchida Tetsuro, Kuroda Yoshinori, Ohba Eiichi, Yamashita Atsushi, Nakai Shingo, Kobayashi Kimihiro, Ochiai Tomonori, Sadahiro Mitsuaki
Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan.
J Card Surg. 2020 Sep;35(9):2403-2406. doi: 10.1111/jocs.14793. Epub 2020 Jul 11.
Approximately 25% of coronary arteriovenous fistulas present aneurysmal dilatation; however, spontaneous rupture of the aneurysm is rare. Most coronary arteries branching the feeding arteries demonstrate aneurysmal formation, possibly because of shunt flow.
A 48-year-old woman was referred to our institution for surgical management of ruptured aneurysm of coronary arteriovenous fistula. The aneurysm was located on the left-anterior aspect of the pulmonary artery trunk, communicating with both left and right coronary arteries through two small feeding arteries draining into the pulmonary artery trunk. Both left and right coronary arteries showed normal diameter. The feeding arteries were ligated externally, and fistulous openings were closed within the aneurysm. Postoperative course was uneventful.
Aneurysm of coronary arteriovenous fistula can occur in patients without aneurysmal coronary artery. Although the association of ruptured aneurysm with coronary fistulas is relatively rare, it should be considered a potential cause of acute cardiac tamponade.
约25%的冠状动脉瘘会出现动脉瘤样扩张；然而，动脉瘤自发破裂很少见。大多数分支供血动脉的冠状动脉显示有动脉瘤形成，可能是由于分流所致。
一名48岁女性因冠状动脉瘘破裂动脉瘤的手术治疗被转诊至我院。动脉瘤位于肺动脉干左前侧，通过两条汇入肺动脉干的小供血动脉与左、右冠状动脉相通。左、右冠状动脉直径均正常。在外部结扎供血动脉，并在动脉瘤内封闭瘘口。术后病程平稳。
冠状动脉瘘的动脉瘤可发生于无动脉瘤样冠状动脉的患者。虽然动脉瘤破裂与冠状动脉瘘的关联相对少见，但应将其视为急性心脏压塞的潜在原因。
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