ANJİYOGRAFİDE ABARTILI NEOVASKÜLARİTE İLE KENDİNİ GÖSTEREN VE SOL ATRİYUMA DRENAJ YERİ ATİPİK OLAN BİR KORONER-KAMERAL FİSTÜL OLGUSU

Year 2013, Volume: 14 Issue: 3, 39 - 41, 01.12.2013

Uğur Gürcün Tünay Kurtoğlu Çağdaş Akgüllü Ufuk Eryılmaz

Abstract

GİRİŞ: Bir koroner arterle bir kalp boşluğu arasında miyokardiyal kapiller yatağı köprüleyerek oluşmuş belirgin bağlantı koroner-kameral fistül olarak tanımlanır. Mitral darlık hastalarında, sirkumfleks koroner arterden köken alan fistül ve koroner revaskülarizasyon varlığı, sol atriyal trombüsün bir belirtisidir.OLGU: 51 yaşında eski bir maden işçisi olan erkek hasta hastanemize nefes darlığı ve atipik göğüs ağrısı yakınmaları ile başvurdu. Transtorasik ekokardiyografide mitral darlık ve sol atriyumda trombüs tespit edildi. Transözefajeal ekokardiyografide trombüsün sol atriyum apendiksinden köken alarak interatriyal septum ve atriyum tabanına doğru uzanım gösterdiği gözlemlendi. Koroner anjiyografide sirkumfleks koroner arterden çıkan ve sol atriyum içindeki kitle lezyonuna drene olan yaygın damar ağı görüldü. Hastaya mitral kapak ve koroner-kameral fistülün kapatılmasına yönelik cerrahi planlandı. Operasyonda, atriyum tabanından başlayarak sağ pulmoner ven ağzı seviyesinden interatriyal septum ve mitral kapak anülüsü seviyesine kadar olan mesafeyi kaplayan dev trombüs saptandı. Trombüs dikkatli bir şekilde atriyum duvarından diseke edilerek ayrıldı. Trombüsün altında posterior mitral anülüsten yaklaşık 2-2,5 cm mesafede –süperior pulmoner venler ve atriyal apendiks arasındaki hattın orta noktasında– yerleşimli olan koroner-kameral fistül ostiumu bulundu. Ostium primer olarak sütüre edildi ve mitral kapak replase edildi. SONUÇ: Mitral darlık olgularında sol atriyal trombüse eşlik eden koroner-kameral fistüller değişik şekillerde ortaya çıkabilmektedir. Bu tip koroner-kameral fistüller en sık atriyal apendikse drene olmakla birlikte, fistülün açıldığı yerin kesin olarak saptanabilmesi için sol atriyumun diğer bölgeleri de dikkatli bir şekilde incelenmelidir

Keywords

Koroner-kameral fistül, sol atriyal thrombus, mitral stenoz

A Coronary Cameral Fistula Displaying Exaggerated Neovascularity on Angiogram with Atypical Drainage Site in Left Atrium

Abstract

OBJECTIVE: The term coronary cameral fistula describes a sizeable communication between a coronary artery and a chamber of the heart that bypasses the myocardial capillary bed. In patients with mitral stenosis, coronary revascularization and fistula originating from the circumflex coronary branch is an indicator of left atrial thrombus. CASE: A 51-year-old male who was a former coal miner admitted to our hospital with complaints of shortness of breath and atypical chest pain. Transthoracic echocardiography revealed mitral stenosis and left atrial thrombus. Transesophageal echocardiography showed that the thrombus was spreading out from the left atrial appendix towards the interatrial septum and the base of atrium. Coronary angiogram revealed extensive network of vessels arising from the circumflex coronary artery draining into a solid lesion originating from left atrium. He was scheduled to undergo mitral valve surgery and surgical closure of the coronary cameral fistula. In the operation, giant thrombus extending from the base of atrium to the origin of the right pulmonary vein and down to the interatrial septum and mitral valve annulus was detected. Thrombus was carefully dissected and peeled off from the left atrial wall. Underneath the thrombus –situated at the center of the line between the superior pulmonary veins and atrial appendage– approximately 2-2,5 cm. distant from the posterior mitral annulus, ostium of the coronary cameral fistula was found. The ostium was closed by simple sutures and the mitral valve was replaced. CONCLUSION: Coronary cameral fistulas accompanying left atrial thrombus in cases of mitral stenosis may emerge in variable forms. Although the most common drainage site for these fistulas is atrial appendage, the other regions of left atrium should be carefully inspected for exactly localizing the ostium of the fistula.

Keywords

Coronary cameral fistula, Left atrial thrombus, Mitral stenosis

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