从左旋支到上腔静脉的冠状动脉瘘：手术及随访
Coronary Artery Fistula From the Left Circumflex to the Superior Vena Cava: Surgery and Follow-Up.
作者信息
Sillanmäki Saara, Viitala Iida, Husso Annastiina
机构信息
Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
Department of Cardiothoracic Surgery, Kuopio University Hospital, Kuopio, Finland.
出版信息
JACC Case Rep. 2025 Apr 2;30(7):103408. doi: 10.1016/j.jaccas.2025.103408.
BACKGROUND
A coronary artery fistula (CAF) is an abnormal connection between a coronary artery and another cardiovascular lumen.
CASE SUMMARY
The authors report a case of a large CAF originating from the left circumflex (LCX) and draining into the lower segment of the superior vena cava, resulting a shunt ratio of 1.3. The patient also had a severe bicuspid aortic valve insufficiency and ventricular dilatation yet remained asymptomatic. A single surgical procedure was performed to address both the fistula and the valvular pathology. Postoperative computed tomography angiography revealed a reduced LCX diameter proximal to the fistula site, with evidence of smooth plaque/mild thrombosis in the LCX walls. In addition, the coronary calcium score was high. The patient was on anticoagulant and statins, with low-density lipoprotein level of 1.3 mmol/L.
DISCUSSION
A CAF between the LCX and superior vena cava is exceedingly rare, with limited cases reported and no established management guidelines, complicating clinical decision-making.
背景
冠状动脉瘘（CAF）是冠状动脉与另一个心血管腔之间的异常连接。
病例摘要
作者报告一例源自左旋支（LCX）并引流至上腔静脉下段的大型CAF病例，分流比为1.3。该患者还患有严重的二叶式主动脉瓣关闭不全和心室扩张，但仍无症状。通过单一外科手术解决了瘘管和瓣膜病变问题。术后计算机断层扫描血管造影显示瘘管部位近端的左旋支直径减小，左旋支管壁有光滑斑块/轻度血栓形成的迹象。此外，冠状动脉钙化评分较高。患者正在接受抗凝治疗并服用他汀类药物，低密度脂蛋白水平为1.3 mmol/L。
讨论
左旋支与上腔静脉之间的冠状动脉瘘极为罕见，报道的病例有限且没有既定的管理指南，这使临床决策变得复杂。
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