Brigui M, Remadi F, Belkhiria N, Zemni J, Chabrak S, Gargouri R
Service de Cardiologie, CHU Sahloul, Sousse.
Ann Cardiol Angeiol (Paris). 1995 Feb;44(2):86-90.
The authors report a case of fistula between the left anterior descending artery (LAD) and the pulmonary artery (PA), in which the only clinical expression was angina associated with electrical signs of myocardial ischaemia on exertion. In the absence of any other signs of left-right shunt related to the fistula, the initial diagnosis was that of atherosclerotic coronary artery disease, especially as this 56-year-old man presented three risk factors. Coronary angiography revealed this anomaly and corrected the diagnosis. Surgical closure of the fistula under cardiopulmonary bypass and via a pulmonary artery approach led to resolution of the angina and exertional ischaemia. Similar cases of LAD-PA fistula responsible for angina as the only clinical manifestation and discovered on coronary angiography have been rarely reported in the literature.
作者报告了一例左前降支动脉（LAD）与肺动脉（PA）之间的瘘管病例，其唯一的临床表现是劳力性心绞痛并伴有心肌缺血的电信号。由于不存在与该瘘管相关的任何其他左右分流迹象，最初的诊断为动脉粥样硬化性冠状动脉疾病，尤其是鉴于这位56岁男性有三个危险因素。冠状动脉造影揭示了这一异常并修正了诊断。在体外循环下经肺动脉途径对瘘管进行手术闭合，使心绞痛和劳力性缺血症状得以缓解。文献中很少报道以心绞痛为唯一临床表现且通过冠状动脉造影发现的类似LAD-PA瘘管病例。
