- 期刊
Transcatheter Coil Embolization of a Huge Right Coronary Artery to Right Ventricle Fistula
經皮心導管螺旋線圈栓塞術治療一個巨大的右冠狀動脈至右心室動脈瘻管
摘要
冠狀動脈瘻管是一種罕見的先天性心臟病，對於無症狀的病童可以先觀察，而對有症狀的孩童則須施予適當的藥物或介入性治療。根據文獻，對於有症狀的單一病灶、心導管能安全到達病灶、且無複雜的冠狀血管分枝的病患，適合以心導管彈簧線圈方式栓塞治療。我們發表了一個四歲的男孩，經心導管檢查證實其患有一個巨大的單純性右冠狀動脈至右心室動脈疼管。病患於一歲時，於左下胸骨緣聽診發現2度的連續性心雜音至本院求診。心臟超音波顯示右心室內出現一個連續性分流，與擴大的動脈瘤樣右冠狀動脈。由於無臨床症狀，因此持續追蹤病患。三年後，男童逐漸表現出呼吸喘以及運動負荷減低的症狀，心電圖出現雙側心室肥大，超音波追蹤顯示逐漸擴張的右冠狀動脈。最後經由心導管檢查確定診斷，並以心導管栓塞方式治療，術後病人狀況良好，無併發症產生。結論，心導管彈簧線圈栓塞術是一種安全的冠狀動脈瘻管替代性介入治療，並且，術後持續規則地追蹤其可能出現的併發症是需要的。
並列摘要
Coronary artery fistula is a rare congenital heart disease. Treatment including medical control or intervention is only indicated for symptomatic children. It has been reported that transcatheter coil embolization is appropriate for symptomatic patients with a single fistula, safe accessibility to the feeding coronary artery, and the absence of large branch vessels. In this case report, we present a 4-year-old boy who was found by cardiac catheterization to have a huge isolated right coronary artery-to-right ventricle fistula. The patient initially presented at one year of age with an asymptomatic continuous grade Ⅱ/Ⅵ murmur over the left-lower sternal border. Echocardiography demonstrated a continuous turbulent flow in the right ventricle and a dilated aneurysmal right coronary artery, suggesting the presence of a right coronary artery fistula. As the patient was asymptomatic, he was followed closely without definitive treatment. Over the next three years, he gradually developed mild exertional dyspnea and decreased exercise tolerance. Serial electrocardiograms revealed biventricular hypertrophy, and echocardiography revealed progressive right coronary arterial dilatation. Cardiac catheterization eventually confirmed the diagnosis, and the fistula was occluded by percutaneous transcatheter coil embolization. The boy remained well after the procedure with resolution of his symptoms. In conclusion, coil embolization is a safe alternative for the treatment of coronary artery fistula.
延伸閱讀
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