Koukash Mohammad Nour Aldeen, Hamad Marah, Makhlouf Adeeb, Kakaje Ameer, Alsaid Bayan
Faculty of medicine, Damascus University, Damascus, Syria.
Department of cardiac surgery, Alassad University Hospital, Damascus University, Damascus, Syria.
Int J Surg Case Rep. 2022 Jul;96:107386. doi: 10.1016/j.ijscr.2022.107386. Epub 2022 Jul 6.
Coronary artery abnormalities are uncommon and mostly asymptomatic. The combination of double right coronary artery (RCA) with a fistula and valvar deformity is very rarely reported in the literature. However, it is important to identify these deformities as they have relatively high complication rates.
A 47-year-old male came with chest pain that radiated to the lower jaw. ECG showed equivalent changes. Blood tests including troponin were within normal range. However, echocardiogram showed a severe mitral valve regurgitation with anterior leaflet prolapse and hypokinesia of the ventricular wall. Coronary angiogram showed a double RCA with a complete block in the main RCA and a fistula to the right atrium (RA). The left coronary system showed atherosclerosis in left anterior descending artery (LAD) and circumflex artery (CX). Surgical treatment, including the repair of the RCA-RA fistula, replacement of mitral valve and coronary artery bypass grafting (CABG) were performed. The patient had no complications in the follow-ups.
Coronary fistulas may be congenital or acquired malformations. Their treatment depends on the symptoms, origin, size and the receiving chamber. Furthermore, double RCA is debatable whether the rate of atherosclerosis and other cardiac abnormalities are increased with this anomaly. The surgeon must keep in mind these rare anomalies before cardiac operations.
Double RCA might accompany other deformities which are important to detect before intervention. More studies are required to decrease complications and have better outcomes.
冠状动脉异常并不常见，且大多无症状。文献中极少报道双支右冠状动脉合并瘘管及瓣膜畸形的情况。然而，识别这些畸形很重要，因为它们的并发症发生率相对较高。
一名47岁男性因胸痛放射至下颌前来就诊。心电图显示有相应改变。包括肌钙蛋白在内的血液检查结果均在正常范围内。然而，超声心动图显示重度二尖瓣反流，前叶脱垂，室壁运动减弱。冠状动脉造影显示双支右冠状动脉，主要右冠状动脉完全阻塞，并存在至右心房的瘘管。左冠状动脉系统显示左前降支动脉（LAD）和回旋支动脉（CX）有动脉粥样硬化。进行了手术治疗，包括修复右冠状动脉 - 右心房瘘管、置换二尖瓣和冠状动脉旁路移植术（CABG）。患者在随访中无并发症。
冠状动脉瘘可能是先天性或后天性畸形。其治疗取决于症状、起源、大小和接受腔。此外，双支右冠状动脉是否会增加动脉粥样硬化和其他心脏异常的发生率仍存在争议。心脏手术前，外科医生必须牢记这些罕见的异常情况。
双支右冠状动脉可能伴有其他畸形，在干预前检测这些畸形很重要。需要更多研究以减少并发症并取得更好的结果。
