Coronary Artery Fistula within Large Left Atrial Thrombus in a Patient with Rheumatic Mitral Stenosis: A Case Report and Review

Yıl 2017, Cilt: 20 Sayı: 2, 175 - 178, 01.08.2017

Bernas Altıntaş Derya Deniz Altıntaş Erkan Baysal Tayyar Gökdeniz

Öz

Coronary
artery fistulae, which are connections between coronary artery branches and
cardiac chambers or major vessels, are usually congenital forms of coronary
artery anomalies, but rarely may be acquired because of cardiac trauma,
neovascularity in association with cardiac neoplasm, mural thrombus formation,
or iatrogenic causes. Although half of the patients with coronary artery
fistula remain asymptomatic, these fistulae may lead to angina, syncope,
congestive heart failure, myocardial infarction, and sudden death. Here we
present a case of coronary artery fistula between right coronary artery and
left atrium through a large left atrial thrombus in a patient with rheumatic
mitral stenosis. The diagnosis was confirmed using echocardiography,
conventional and multislice computed tomography, and coronary angiography. To
the best of our knowledge, this interesting and unique entity is the first to
be reported in the present literature.

Anahtar Kelimeler

Coronary artery fistula, left atrial thrombus, rheumatic mitral stenosis

Romatizmal Mitral Stenozu Olan Hastada Büyük Sol Atriyal Trombüs İçine Doğru Seyreden Koroner Arter Fistülü

Öz

Koroner
arter dalları ile kardiyak boşluklar veya büyük damarlar arasındaki normal dışı
bağlantılar olan koroner arter fistülleri (KAF) genellikle koroner arter anomalilerinin
konjenital formlarıdır. Fakat nadiren kardiyak travma, iyatrojenik nedenler
veya kardiyak neoplazm ve mural trombüs oluşumu ile ilişkili
neovaskülarizasyona ikincil edinsel olabilir. KAF’ı olan hastaların yaklaşık
yarısının asemptomatik kalmasına rağmen bu fistüller anjina, senkop, konjestif
kalp yetmezliği, miyokart infarktüsü ve ani ölüme yol açabilirler. Bu yazıda
romatizmal mitral kapak stenozu olan bir hastada sağ koroner arter (RCA) ile
sol atriyum (LA) arasında, büyük LA trombüs içine açılan KAF’ı sunuyoruz. Tanı
2 boyutlu ekokardiyografi, konvansiyonel koroner anjiyografi ve çok kesitli
bilgisayarlı tomografik koroner anjiyografi kullanılarak doğrulandı. Bildiğimiz
kadarı ile bu ilginç ve benzersiz durum mevcut literatürde ilk defa raporlanmıştır.

Anahtar Kelimeler

Koroner arter fistülü, sol atriyal trombüs, romatizmal mitral kapak darlığı

Kaynakça

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