Department of Cardiology & Vascular Medicine, Dr Soetomo General Hospital, Indonesia.
J Pak Med Assoc. 2024 Jun;74(6 (Supple-6)):S57-S60. doi: 10.47391/JPMA.xxx.
Coronary artery fistula is a rare anomaly involving the coronary artery and a heart chamber or vessel. Percutaneous intervention has been shown to be effective and safe in fistulas that are small and nontortuous; however, it is not an absolute contraindication in fistulas that are large and tortuous. We report a delayed diagnosis of a single, large-diameter, tortuous coronary artery fistula that manifested as myocardial ischaemia due to the steal phenomenon in a 49 year old male. The undesirable connection was successfully obliterated by percutaneous embolisation, followed by an improvement in symptoms and daily activities. Steal phenomenon is the fundamental mechanism of myocardial ischaemia in coronary artery fistula, as confirmed by improvement in symptoms and coronary artery perfusion following occlusion of the fistula. Percutaneous catheterization is safe and effective for coronary artery fistula closure, and the occlusion site should be precise to achieve complete occlusion and prevent complications.
冠状动脉瘘是一种罕见的异常情况，涉及冠状动脉和心脏腔室或血管。经皮介入治疗已被证明对小而无扭曲的瘘管有效且安全；然而，对于大而扭曲的瘘管，它并不是绝对禁忌。我们报告了一例单发、大直径、扭曲的冠状动脉瘘的延迟诊断，该瘘由于窃血现象导致 49 岁男性心肌缺血。通过经皮栓塞成功地闭塞了不理想的连接，随后症状和日常活动得到改善。窃血现象是冠状动脉瘘心肌缺血的根本机制，通过闭塞瘘管后症状和冠状动脉灌注的改善得到证实。经皮导管插入术对于冠状动脉瘘的闭合是安全有效的，并且闭塞部位应该精确以实现完全闭塞并防止并发症。
