The Current Status of Coronary Artery Fistula

冠狀動脈廔管的目前現況

林志達(Chih-Ta Lin) ； 林庭光(Tin-Kwang Lin)

《內科學誌》 20卷6期 (2009/12) Pp. 484-489

https://doi.org/10.6314/JIMT.2009.20(6).02

摘要

冠狀動脈廔管是一種少見的冠狀動脈異常。大部分爲先天性，但隨著介入性設備及技術使用的增加，後天性的原因逐漸增加。本症的盛行率在心導管或心臟超音波的研究中約爲0.1-0.8%。本症好發於右冠狀動脈及左前降枝動脈，且以近端侵犯爲主。大多數會引流至右心房、右心室或肺動脈，少數會引流至左心房或左心室。根據廔管引流部位之不同，會有不同的生理學表現。臨床上約半數之冠狀動脈廔管不會產生症狀。較大之廔管可造成心衰竭、心絞痛、心肌梗塞、心律不整、或肺動脈高壓。其他像心內膜炎、冠狀動脈破裂、猝死也有文獻報告過。理學檢查常可聽到連續性雜音。鉈201心肌灌注掃描可用來幫助診斷心肌缺血。冠狀動脈血管攝影爲主要診斷工具。心臟超音波、核磁共振及多切面電腦斷層也常被用來幫助診斷。治療可分爲內科治療、經心導管關閉廔管或外科廔管結紮，但必須根據廔管之大小、位置、病人年齡及臨床症狀來做不同的考量。冠狀動脈廔管在東方人的表現也將在文章中予以探討。

並列摘要

Coronary artery fistula (CAF) is an unusual coronary anomaly. Most coronary artery fistulas are congenital, but the incidence of acquired CAFs is increasing following the incremental use of intravascular procedures and interventional techniques. The prevalence of CAF is about 0.1-0.8% based on coronary angiography or echocardiography studies. CAFs originate mostly from the right coronary artery and the left anterior descending artery and have proximal involvement. Most of them drain into the right atrium, right ventricle and pulmonary artery. Few of them drain into the left ventricle or left atrium. According to the site of drainage, CAFs have varied physiologic presentations. Clinically, about half of patients with a CAF are asymptomatic. Large fistulas can induce congestive heart failure, angina, myocardial infarction, arrhythmia or pulmonary hypertension. Endocarditis, coronary artery rupture and sudden cardiac death have also been reported. Physical examination usually reveals a continuous murmur. Myocardial ischemia with abnormal 201Tl perfusion image can be detected in large portion of patients with CAF. Coronary angiography is the major diagnostic tool. Cardiac echocardiography, magnetic resonance imaging and multidetector computed tomography are also used for diagnosis. Treatment includes medical therapy, transcatheter closure of the fistula or surgical ligation of the fistula. However, these treatments should be tailored according to the size and location of fistula, and the patient's age and clinical presentation. The characteristics of CAFs in Oriental people were also discussed in this article.

並列關鍵字

Coronary artery fistula ； Coronary anomaly ； Angina pectoris