Shah Love, Kundapur Deeksha, Nosib Shravan
Internal Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
BMJ Case Rep. 2021 Mar 24;14(3):e242425. doi: 10.1136/bcr-2021-242425.
We present the case of a 61-year-old woman with chest pain syndrome. Cardiac catheterisation did not reveal atherosclerotic coronary disease. However, a haemodynamically significant fistula connecting the left coronary artery to the left atrial appendage was found to be the culprit through a left-to-left shunting mechanism. In this report, we review the pathophysiology of coronary artery fistulas and the mechanism by which these fistulas may lead to 'coronary steal syndrome'. Indications for interventional and surgical management are outlined. Ultimately, we suggest the consideration of coronary artery fistulas in the differential diagnosis of patients presenting with chest pain.
我们报告一例61岁胸痛综合征女性病例。心脏导管检查未发现动脉粥样硬化性冠状动脉疾病。然而，通过左向左分流机制发现，一条连接左冠状动脉与左心耳的具有血流动力学意义的瘘管是病因。在本报告中，我们回顾了冠状动脉瘘的病理生理学以及这些瘘管可能导致“冠状动脉窃血综合征”的机制。概述了介入和手术治疗的适应证。最终，我们建议在胸痛患者的鉴别诊断中考虑冠状动脉瘘。
