Yokoyama Shigeki, Nagao Kanetsugu, Higashida Akihiko, Aoki Masaya, Yamashita Shigeyuki, Yamashita Akio, Doi Toshio, Fukahara Kazuaki, Yoshimura Naoki
Department of Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan.
J Surg Case Rep. 2021 Jul 8;2021(7):rjab286. doi: 10.1093/jscr/rjab286. eCollection 2021 Jul.
A coronary artery fistula is a rare condition caused by abnormal coronary artery embryological development. Although most cases are asymptomatic, in some, the large shunt volume and the myocardial ischemia due to the steal phenomenon require surgical treatment. We present the case of a 40-year-old woman who presented with angina on exertion. Enhanced computed tomography showed a giant right coronary artery (RCA) aneurysm with an RCA-to-right atrium fistula. Because of the presence of symptoms and the presence of large fistulous tract, the patient was considered a surgical candidate. The procedure was performed under cardiopulmonary bypass. Ligation and closure of the fistula were performed in combination with dissection of the enlarged main trunk of the RCA and coronary artery bypass using the internal thoracic artery because of its potential for long-term patency. The postoperative course was uneventful.
冠状动脉瘘是一种由冠状动脉胚胎发育异常引起的罕见病症。虽然大多数病例无症状，但在一些病例中，由于窃血现象导致的大量分流和心肌缺血需要手术治疗。我们报告一例40岁女性患者，其表现为劳力性心绞痛。增强计算机断层扫描显示巨大的右冠状动脉（RCA）瘤合并RCA至右心房瘘。由于存在症状以及存在较大的瘘管，该患者被认为是手术候选者。手术在体外循环下进行。由于胸廓内动脉具有长期通畅的潜力，因此在结扎和闭合瘘管的同时，对扩大的RCA主干进行解剖，并使用胸廓内动脉进行冠状动脉搭桥。术后过程顺利。
