因巨大冠状动脉瘘导致的非出血性心包积液伴心脏压塞和心源性休克
Nonhemorrhagic Pericardial Effusion With Tamponade and Cardiogenic Shock Due to Large Coronary Artery Fistula.
作者信息
von Sanden Felix, Skrabal Christian, Arab Muhammad, Liebold Andreas, Rottbauer Wolfgang, Buckert Dominik
机构信息
Department of Internal Medicine II, Cardiology, Angiology, Pneumology, Internal Intensive Care, Sports- and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany.
Department of Cardiac Surgery, Ulm University Medical Center, Ulm, Germany.
出版信息
JACC Case Rep. 2025 Mar 5;30(5):103026. doi: 10.1016/j.jaccas.2024.103026.
BACKGROUND
Coronary artery fistulas (CAFs) are a rare congenital heart disease. Large fistulas can lead to coronary steal phenomena presenting with angina, heart failure, and in rare cases, cardiogenic shock.
CASE SUMMARY
A 55-year-old woman acutely presented at our heart center with nonhemorrhagic pericardial tamponade and cardiogenic shock. A large CAF of an aneurysmatic right coronary artery to the coronary sinus was diagnosed. Pericardiocentesis was used for initial hemodynamic stabilization. On cardiopulmonary bypass, perforations connecting right coronary artery and coronary sinus were closed via suture.
DISCUSSION
In cases of CAF, cardiogenic shock with pericardial tamponade is usually caused by rupture of an aneurysmatic vessel with successive hemopericardium. In this case, the pericardial tamponade was caused by acute right heart decompensation after long-term right ventricular overload.
TAKE-HOME MESSAGES: In adult right heart failure, early comprehensive cardiac imaging is essential for diagnosis of rare underlying congenital diseases. Surgical shunt closure can drastically improve symptoms.
背景
冠状动脉瘘（CAF）是一种罕见的先天性心脏病。大型瘘可导致冠状动脉窃血现象，表现为心绞痛、心力衰竭，罕见情况下可出现心源性休克。
病例摘要
一名55岁女性因非出血性心包填塞和心源性休克紧急就诊于我院心脏中心。诊断为右冠状动脉瘤样扩张至冠状窦的大型冠状动脉瘘。心包穿刺术用于初始血流动力学稳定。在体外循环下，通过缝合关闭连接右冠状动脉和冠状窦的穿孔。
讨论
在冠状动脉瘘病例中，伴有心包填塞的心源性休克通常是由动脉瘤样血管破裂并继发心包积血引起的。在本病例中，心包填塞是由长期右心室超负荷后急性右心失代偿所致。
经验教训
在成人右心衰竭中，早期全面的心脏成像对于诊断罕见的潜在先天性疾病至关重要。手术关闭分流可显著改善症状。
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