George Blessen, Sood Michael R
Department of Medicine, Mount Sinai South Nassau, One Healthy way, Oceanside, New York, USA.
Icahn School of Medicine at Mount Sinai, New York, USA.
JRSM Cardiovasc Dis. 2022 Mar 10;11:20480040221082905. doi: 10.1177/20480040221082905. eCollection 2022 Jan-Dec.
With an incidence of less than 1%, a Coronary Artery to Pulmonary Artery fistula (CAPF) is a rare coronary anomaly that causes heart failure. It causes a left to right cardiac shunt. While guidelines favor surgical correction in symptomatic patients, we present a challenging case with multiple cardio-thoracic pathologies.
We present a 38-year-old obese male with persistent atrial fibrillation (AF). He presented to our hospital in decompensated heart failure and AF with rapid ventricular response. He was found to have a CAPF, a bicuspid aortic valve and left lung hypoplasia in the presence of severely reduced left ventricular systolic dysfunction. The patient subsequently underwent various cardiac testing demonstrating advanced anatomical and physiologic involvement of his CAPF, including suggested coronary steal. Despite some indications for percutaneous or surgical referral, we optimized his AF and congestive heart failure in lieu of formulating a treatment strategy for his CAPF and other abnormalities.
This report illustrates a case of a young adult who presented in decompensated heart failure with newly diagnosed left ventricular systolic function and rapid AF, who had a triad of congenital defects including a . To the best of our knowledge, this triad of defects is unreported. This case highlights the clinical approach in the evaluation of a cardiac shunt and it's management strategies in the presence of multiple cardio-thoracic comorbidities.
冠状动脉至肺动脉瘘（CAPF）发病率低于1%，是一种罕见的冠状动脉异常，可导致心力衰竭。它会引起心脏从左向右分流。虽然指南倾向于对有症状的患者进行手术矫正，但我们报告了一例具有多种心胸疾病的具有挑战性的病例。
我们报告一名38岁肥胖男性，患有持续性心房颤动（AF）。他因失代偿性心力衰竭和快速心室反应性房颤入住我院。在左心室收缩功能严重降低的情况下，发现他患有冠状动脉至肺动脉瘘、二叶式主动脉瓣和左肺发育不全。该患者随后接受了各种心脏检查，结果显示其冠状动脉至肺动脉瘘存在严重的解剖和生理病变，包括提示的冠状动脉窃血。尽管有一些经皮或手术转诊的指征，但我们优化了他的房颤和充血性心力衰竭，而没有为其冠状动脉至肺动脉瘘和其他异常制定治疗策略。
本报告阐述了一例年轻成人病例，该患者因新诊断的左心室收缩功能和快速房颤出现失代偿性心力衰竭，且患有包括……在内的先天性缺陷三联征。据我们所知，这种缺陷三联征尚未见报道。该病例突出了心脏分流评估中的临床方法及其在存在多种心胸合并症时的管理策略。
