Robu Mircea, Radulescu Bogdan, Nayyerani Reza, Enache Robert, Stiru Ovidiu, Iosifescu Andrei, Olaru Georgiana, Ciomag Ianula Raluca, Iliescu Vlad Anton, Moldovan Horatiu
Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania.
J Clin Med. 2024 Apr 16;13(8):2297. doi: 10.3390/jcm13082297.
Coronary artery fistulas draining into the left ventricle is a rare finding. They can be associated with other congenital cardiac anomalies like ventricular septal defect or tetralogy of Fallot. While most of them are asymptomatic, they can lead to severe cardiac complications like infective endocarditis, heart failure, or myocardial ischemia. Symptomatic coronary artery fistulas can be managed surgically or percutaneously. We present a case of a 61-year-old male patient with both left anterior descending artery and right coronary artery fistulas draining into the left ventricle associated with ascending aorta and root aneurysm. Preoperative assessment for myocardial ischemia and the size and location of the fistulas was performed. The echocardiography stress test was negative. Surgery consisted of replacement of the ascending aorta and reconstruction of the noncoronary sinus with a Dacron patch with aortic valve preservation and no intervention for the coronary artery fistulas. The surgical strategy was adapted for cardioplegia administration to compensate for the volume of coronary blood drained into the left ventricle and for better protection of the distal myocardium.
冠状动脉瘘引流至左心室是一种罕见的情况。它们可能与其他先天性心脏异常相关，如室间隔缺损或法洛四联症。虽然大多数患者无症状，但它们可导致严重的心脏并发症，如感染性心内膜炎、心力衰竭或心肌缺血。有症状的冠状动脉瘘可通过手术或经皮方式进行治疗。我们报告一例61岁男性患者，其左前降支动脉和右冠状动脉瘘均引流至左心室，并伴有升主动脉和主动脉根部瘤。对心肌缺血以及瘘的大小和位置进行了术前评估。超声心动图负荷试验为阴性。手术包括升主动脉置换和用涤纶补片重建无冠窦，同时保留主动脉瓣，未对冠状动脉瘘进行干预。手术策略进行了调整，以便进行心脏停搏液灌注，以补偿引流至左心室的冠状动脉血流量，并更好地保护远端心肌。
