Coexistent mitral Stenosis and Coronary Artery Fistula Presenting as Myocardial Ischemia: Case Report

冠狀動脈廔管大多是先天性的疾病，且都在小孩或年輕時就被診斷出來。50,000例小兒先天性心臟病中才有一例。而在每500位接受冠狀動脈攝影的患者中，也約只有一例冠狀動脈廔管。右冠狀動脈是最常發生的，常與右心或肺動脈有交通。高雄醫學院附設中和醫院報告一例50歲女性患者因心衰竭曾入院三次，診斷為二尖瓣狹窄併肺動脈高血壓，從心電圖上發現有嚴重的心肌缺氧(S-T segment depression)。病人合併的完狀動脈廔管因嚴重的心臟疾病而隱藏。心導管的檢查發現，從左前下降枝冠狀動脈有廔管通到肺動脈，入口有兩個以上。沒有發現冠狀動脈狹窄的病變。在體外循環下，病人接受二尖瓣置換術及打開肺動脈估廔管結紮。術後病人恢復情況相當良好，心電圖上顯示心肌缺氧有顯著的進步，胸部X光可看見心臟肥大及肺充血的情形也大幅改善。回顧文獻，冠狀動脈廔管合併心臟病變的比率約佔三分之一。相反的，二尖瓣狹窄合併冠狀動脈廔管的病例卻屬少見，高雄醫學院附設中和醫院接受二尖瓣手術的250位患者中，就只有此例合併有冠狀動脈廔管。此例報告也提供我們一個寶貴的經驗：如果病人臨床上有心肌缺氧、心衰竭、心內膜炎或甚至心肌梗塞，卻沒有明顯的病因時，冠狀動脈廔管雖然是少見的疾患，且可能為併存的嚴重心臟疾病所掩藏，但仍需列入考慮。

關鍵字

無資料

並列摘要

We report a 50-year-old female case of mitral stenosis with congenital coronary artery fistula communicating the left anterior descending artery to pulmonary artery. Inreviewing the literature, mitral stenosis associated with coronary artery fistula is rare. The case was initially treated medically for congestive heart failure. The electrocardiogram revealed severe myocardial ischemia and no obvious etiology was found clinically. The coronary angiogram demonstrated the diagnosis of coronary artery fistula. Myocardial ischemia improved markedly after surgical correction of the valvular disease and the fistula. The patient continued to do well during 2 years and 10 months follow up. The concomitant mitral stenosis masked the symptoms of coronary artery fistula, and made us fail to diagnose the condition initially. Valvular heart disease associated with severe myocardial ischemia without obvious atherosclerotic stenossi of coronary artery reminded us of the possibility of coronary artery fistula, though it has rarely been reported.

並列關鍵字

coronary artery fistula ； mitral sttenosis ； myocardial ischemia

國際替代計量

Coexistent mitral Stenosis and Coronary Artery Fistula Presenting as Myocardial Ischemia: Case Report

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