Jian Chuanmin, Liu Song, Song Kang, Zhou Jie, Shi Shaoting
Department of Cardiovascular Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China.
Department of Cardiovascular Medicine, Qingdao University, Qingdao, China.
Medicine (Baltimore). 2025 Mar 14;104(11):e41929. doi: 10.1097/MD.0000000000041929.
Coronary artery perforation (CAP) is one of the most serious complications of percutaneous coronary intervention. Coronary arteriovenous fistula is a considerably rare type of congenital CAP. They are usually difficult to distinguish.
A male patient developed coronary artery perforation during percutaneous coronary intervention. As balloon occlusion was ineffective, a decision was made to implant a spring coil and bypass the occluded segment. However, the placement of spring coils restored patency in the occluded distal segment of the right coronary artery (RCA).
Coronary computed tomography angiography is an auxiliary tool and Digital Subtraction Angiography(DSA) is the gold standard for the diagnosis.
Surgery and implant a spring coil are the main treatment methods.
The patient's RCA regained its blood supply. Coronary artery recanalization arteries occurred after spring coil placement. Combined with the imaging presentation, we finally determined that he was coronary-right ventricular fistula.
Although congenital CAPs are rare, appropriate detection and timely confirmation by coronary angiography are important for determining their subsequent management. Congenital coronary arteriovenous fistulae may be considered when coronary artery perforation during percutaneous coronary intervention, balloon blockade is ineffective and the patient's vital signs are stable.
冠状动脉穿孔(CAP)是经皮冠状动脉介入治疗最严重的并发症之一。冠状动脉动静脉瘘是先天性CAP中相当罕见的一种类型。它们通常难以区分。
一名男性患者在经皮冠状动脉介入治疗期间发生冠状动脉穿孔。由于球囊闭塞无效,决定植入弹簧圈并绕过闭塞段。然而,弹簧圈的放置恢复了右冠状动脉(RCA)闭塞远端段的通畅。
冠状动脉计算机断层扫描血管造影是一种辅助工具,数字减影血管造影(DSA)是诊断的金标准。
手术和植入弹簧圈是主要治疗方法。
患者的RCA恢复了血供。弹簧圈放置后出现冠状动脉再通。结合影像学表现,我们最终确定他为冠状动脉-右心室瘘。
尽管先天性CAP很少见,但通过冠状动脉造影进行适当检测并及时确诊对于确定其后续治疗很重要。在经皮冠状动脉介入治疗期间发生冠状动脉穿孔、球囊封堵无效且患者生命体征稳定时,可考虑先天性冠状动脉动静脉瘘。