Poretti Giulia, Lo Rito Mauro, Varrica Alessandro, Frigiola Alessandro
Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097, San Donato Milanese, Italy.
Eur Heart J Case Rep. 2020 Oct 27;4(6):1-6. doi: 10.1093/ehjcr/ytaa297. eCollection 2020 Dec.
Isolated coronary arteriovenous fistulas are extremely rare, accounting for 0.08-0.4% of all congenital heart disease. Closure of the fistula is recommended in cases of large dimensions, relevant left-right shunt, or ischaemic events. Thrombosis of the coronary aneurysms may occur as a postoperative complication.
We report a case of a coronary fistula between the circumflex artery and coronary sinus with giant aneurysm. After a failed percutaneous closure attempt, the patient was surgically treated without major postoperative complications. Despite therapeutic anticoagulation and antiplatelet therapy, she presented at clinical follow-up with thrombosis of the dilated coronary artery without signs or symptoms of ischaemia.
Management of coronary artery fistula may be challenging in cases in which initial percutaneous closure is unsuccessful. This particular case also highlights the importance of close follow-up, despite optimal therapy, to detect potentially lethal complications related to the low flow in the dilated coronary aneurysm.
孤立性冠状动脉瘘极为罕见，占所有先天性心脏病的0.08 - 0.4%。对于瘘口较大、存在明显左右分流或有缺血事件的病例，建议进行瘘口闭合术。冠状动脉瘤血栓形成可能是术后并发症。
我们报告一例回旋支动脉与冠状窦之间的冠状动脉瘘合并巨大动脉瘤的病例。经皮闭合尝试失败后，患者接受了手术治疗，术后无重大并发症。尽管进行了治疗性抗凝和抗血小板治疗，但在临床随访时，她出现了扩张冠状动脉的血栓形成，且无缺血的体征或症状。
在初始经皮闭合失败的病例中，冠状动脉瘘的管理可能具有挑战性。这个特殊病例还强调了密切随访的重要性，尽管进行了最佳治疗，但仍要检测与扩张冠状动脉低流量相关的潜在致命并发症。
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