Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.
Pediatr Cardiol. 2023 Apr;44(4):951-954. doi: 10.1007/s00246-023-03140-x. Epub 2023 Mar 13.
Coronary artery-to-pulmonary artery fistulae are a not uncommon finding in patients with Tetralogy of Fallot (TOF) and collateral-dependent pulmonary blood flow. Management for these fistulae is often primary surgical ligation or unifocalization at the time of complete repair, dependent on the presence of dual blood flow to the involved areas. We present the case of a 32-week premature boy weighing 1.79 kg with TOF, confluent branch pulmonary arteries, major aortopulmonary collaterals, and right coronary artery to main pulmonary artery fistula. The patient demonstrated evidence of coronary steal into the pulmonary vasculature with an elevation in the troponin level without hemodynamic instability, and subsequently underwent successful transcatheter occlusion of the fistula via right common carotid access using a Medtronic 3Q microvascular plug. This case demonstrates the realistic potential for early coronary steal in this physiology and possibility of transcatheter therapy even in a small neonate.
冠状动脉-肺动脉瘘在法洛四联症（TOF）和依赖侧支循环的肺血流患者中并不少见。这些瘘管的治疗通常是在完全修复时进行主要的手术结扎或单腔化，这取决于受累区域是否存在双血流。我们报告了一例 32 周早产男婴，体重 1.79 公斤，患有 TOF、融合分支肺动脉、主肺动脉侧支循环和右冠状动脉至主肺动脉瘘。该患者出现了冠状窃血进入肺血管系统的证据，肌钙蛋白水平升高，但无血流动力学不稳定，随后通过右侧颈总动脉入路使用美敦力 3Q 微血管塞成功地进行了瘘管的经导管闭塞。这个病例说明了在这种生理条件下早期冠状窃血的现实可能性，甚至在小新生儿中也有可能进行经导管治疗。
