Hirota J, Akiyama K, Takazawa A, Hashimoto A, Sasaki S, Nagumo T
Department of Cardiovascular Surgery, Iwaki Kyoritsu General Hospital, Fukushima, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 Oct;45(10):1782-6.
A surgical case of rare coronary artery fistula between the left circumflex artery and right ventricle was reported. A 46-year-old woman had suffered from exertional dyspnea and palpitation for three years. Pan systolic heart murmur was heard through the left 4th inter costal space. The chest X-ray film demonstrated cardiac enlargement and lung congestion, and the electrocardiograms showed atrial fibrillation and left ventricular hypertrophy when she was admitted to our hospital. Preoperative catheterization revealed a huge coronary artery fistula originating from the left circumflex artery and opening into the right ventricle through the posterior wall of the heart. The left-to-right shunt ratio was 60% and Qp/Qs was 2.47. At operation, the dilated circumflex artery fistula was carefully dissected and the tape was passed around the fistula as a tourniquet under extra corporeal circulation on the beating heart. To estimate myocardial ischemia, the fistula occlusion test was performed by tightening the previously placed tourniquet. Monitoring of electrocardiograms, transesophageal echocardiography, and hemodynamics were useful to detect myocardial ischemia. The occlusion test was performed under ECC for 5 minutes. No ischemic changes were observed. The fistula was interrupted under cardiac arrest at the point of the occlusion test.
报告了一例罕见的左旋支动脉与右心室之间的冠状动脉瘘手术病例。一名46岁女性因劳力性呼吸困难和心悸三年就诊。于左侧第4肋间可闻及全收缩期心脏杂音。入院时胸部X线片显示心脏增大和肺淤血，心电图显示房颤和左心室肥厚。术前心导管检查显示巨大冠状动脉瘘起源于左旋支动脉，经心脏后壁开口于右心室。左向右分流率为60%，肺循环血流量与体循环血流量之比（Qp/Qs）为2.47。手术中，在心脏跳动的体外循环下，小心解剖扩张的左旋支动脉瘘，并用带子环绕瘘管作为止血带。为评估心肌缺血，通过收紧先前放置的止血带进行瘘管闭塞试验。监测心电图、经食管超声心动图和血流动力学有助于检测心肌缺血。在体外循环下进行闭塞试验5分钟。未观察到缺血改变。在闭塞试验部位心脏停搏时中断瘘管。
