Zhang Qiuxia, Chen Yaode, Hou Yuqing, Xiu Jiancheng
Department of Cardiology, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou 510515, China.
Eur Heart J Case Rep. 2021 Jan 16;5(1):ytaa581. doi: 10.1093/ehjcr/ytaa581. eCollection 2021 Jan.
Coronary artery fistula complicated with giant coronary artery ectasia (CAE) is a rare cardiac malformation, and its surgical indications and treatment strategies still need further discussion.
In this case, a 41-year-old man had complained of occasional dizziness for 2 years, but he did not seek medical attention until he started to feel palpitations. A right coronary artery (RCA)-left ventricular (LV) fistula with giant RCA of diffuse ectasia was firstly revealed by transthoracic echocardiography. A widened left ventricle and significantly constricted right atrium and right ventricle were also detected by three-dimensional coronary artery computed tomography. Surgical treatment, including the repair of the RCA-LV fistula, the resection and reconstruction of the dilated RCA and coronary artery bypass grafting (CABG) under hypothermic cardiopulmonary bypass, were performed to correct the malformation. The patient presented a favourable health condition without any discomfort at the 1-year follow-up.
CAE can be caused by various congenital or acquired factors. Surgical treatment, such as transcatheter embolization excision, surgical ligation or resection for symptomatic patients with CAE three times or larger than the reference diameter, has been reported to have satisfactory results. Additionally, CABG can be selected if myocardial perfusion is compromised and the distal branch is of reasonable size. In this case, the giant ectasia of the RCA may have been a consequence of the congenital RCA-LV fistula. Atherosclerosis, with calcified plaques in the RCA, and the patient's long-term history of smoking may have contributed to the development of giant ectasia of the RCA.
冠状动脉瘘合并巨大冠状动脉扩张（CAE）是一种罕见的心脏畸形，其手术指征和治疗策略仍需进一步探讨。
该病例中，一名41岁男性2年来偶尔感到头晕，但直到开始出现心悸才就医。经胸超声心动图首先发现右冠状动脉（RCA）-左心室（LV）瘘合并弥漫性扩张的巨大RCA。三维冠状动脉计算机断层扫描还检测到左心室扩大以及右心房和右心室明显狭窄。在低温体外循环下进行了手术治疗，包括修复RCA-LV瘘、切除并重建扩张的RCA以及冠状动脉旁路移植术（CABG），以纠正畸形。患者在1年随访时健康状况良好，无任何不适。
CAE可由多种先天性或后天性因素引起。对于CAE直径是参考直径三倍或更大的有症状患者，经导管栓塞切除、手术结扎或切除等手术治疗已被报道有满意效果。此外，如果心肌灌注受损且远端分支大小合适，可选择CABG。在该病例中，RCA的巨大扩张可能是先天性RCA-LV瘘的结果。RCA中存在钙化斑块的动脉粥样硬化以及患者长期吸烟史可能促成了RCA的巨大扩张。
