一名老年不稳定型心绞痛患者的多发冠状动脉瘘和三支血管病变
Multiple Coronary Artery Fistulas and 3-Vessel Disease in an Elderly Patient With Unstable Angina.
作者信息
Rodríguez Edwin A, Martinez Soley Tatiana M, Restrepo Carolina Escobar, Medrano Carlos A, Vargas Pelaez Alvaro F, Pérez de la Hoz Ricardo A
机构信息
Department of Cardiology, José de San Martín Hospital, University of Buenos Aires, Buenos Aires, Argentina.
Department of Cardiology, José de San Martín Hospital, University of Buenos Aires, Buenos Aires, Argentina.
出版信息
JACC Case Rep. 2025 Sep 17;30(28):105072. doi: 10.1016/j.jaccas.2025.105072.
BACKGROUND
Coronary artery fistula (CAF) is an atypical vascular communication that drains into a cardiac chamber or vessel and is usually unrelated to atherosclerotic coronary artery disease (CAD).
CASE SUMMARY
An elderly patient with high-risk unstable angina underwent coronary angiography, which revealed 3-vessel CAD and multiple CAFs. Medical treatment was elected.
DISCUSSION
Multiple CAFs, especially a large right CAF draining into the left ventricle in the context of significant 3-vessel CAD in an elderly patient, represent a rare finding with an unusual presentation of unstable angina. This case highlights the diagnostic challenges and management considerations in such complex scenarios, enriching the limited available literature.
TAKE-HOME MESSAGE: The co-occurrence of multiple CAFs with CAD creates a unique management challenge, requiring a tailored approach that extends beyond the current limited literature.
背景
冠状动脉瘘（CAF）是一种非典型的血管交通，其引流至心腔或血管，通常与动脉粥样硬化性冠状动脉疾病（CAD）无关。
病例摘要
一名患有高危不稳定型心绞痛的老年患者接受了冠状动脉造影，结果显示三支血管CAD和多处CAF。选择了药物治疗。
讨论
多处CAF，尤其是在一名老年患者存在严重三支血管CAD的情况下，有一条大的右冠状动脉瘘引流至左心室，这是一种罕见的发现，伴有不稳定型心绞痛的异常表现。该病例凸显了此类复杂情况下的诊断挑战和管理考量，丰富了有限的现有文献。
要点
多处CAF与CAD同时存在带来了独特的管理挑战，需要一种超越当前有限文献的定制方法。
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