右冠状动脉扩张合并左心室瘘一例

Right Coronary Artery Dilatation with Left Ventricular Fistula: A Case Report

摘要: 冠状动脉瘘是一种罕见的心血管畸形，包括先天性和非先天性。先天性冠状动脉瘘形成的病因是患者在胎儿期心肌发育局部停止，因心肌肌小梁间的窦状间隙无法退化而形成的，较为常见；非先天性的多由外伤、心血管介入治疗、冠状动脉旁路移植术、动脉粥样硬化、大动脉炎等因素导致，非先天性因素较为罕见。其临床表现多为活动后胸闷、心悸、心绞痛等类似于冠心病的症状，发病时期较早，运用心脏彩超、冠脉造影等检查较易确诊，目前治疗方式主要是经导管介入治疗及外科手术，但由于此类疾病较罕见，且解剖变异种类较多，对于手术的选择及术后并发症的处理仍经验不足，我们在此报告一例25岁男性患者，该患者经影像学检查确诊为右冠脉扩张合并左心室瘘，经外科手术治疗后，病情缓解出院。

Abstract: Coronary artery fistula is a rare cardiovascular malformation, including congenital and non congenital. The cause of congenital coronary artery fistula is that the development of myocardium stops locally in fetal period, and the sinus space between myocardial trabeculae cannot be degenerated, it’s more common; non congenital factors are mostly caused by trauma, cardiovascular intervention, coronary artery bypass grafting, atherosclerosis, takayasu arteritis and other factors, and non congenital factors are rare. Its clinical manifestations are chest tightness, palpitation, angina pectoris and other symptoms similar to coronary heart disease. The onset period is early, and it is easy to be diagnosed by echocardiography, coronary angiography and other examinations. At present, the main treatment methods are transcatheter interventional therapy and surgical operation. However, due to the rarity of this kind of disease and the variety of anatomical variation, the choice of operation and the management of postoperative complications are still inexperienced, we report a 25-year-old male patient who was diagnosed with right coronary artery dilatation and left ventricular fistula by imaging examination. After surgical treatment, the patient was discharged from hospital in remission.