Surgical Repair of Fistula Between Right Coronary Artery and Main Pulmonary Artery: Case Report

Öz

Coronary artery fistulas (CAF) are uncommon cases. They may cause myocardial ischemia, arrhythmia, pulmonary hypertension, and heart failure. Treatment options are controversial and not clear. In this article we report surgical management of a case with right coronary artery fistula and concurrent coronary artery disease. A sixty-years-old male patient with stable angina symptoms admitted to our medical center. Coronary angiography examination showed a right coronary artery to pulmonary artery fistula and significant right coronary artery lesion located after the fistula's origin. CAF ligated epicardially and right coronary revascularization was performed. Coronary arterial fistulas cause important hemodynamic problems. Surgical and transcatheter interventional treatments are treatment options. Therefore indications for treatment are very important for these patients. The best therapeutic strategy (surgery or transcatheter intervention) is debatable. The surgical treatment is controversial especially for asymptomatic and small fistulas. However, there is consensus that large and symptomatic fistulas should be treated. Further research is necessary to deepen these observations.

Anahtar Kelimeler

• Coronary artery fistula
• right coronary artery
• pulmonary artery
• coronary artery disease

Sağ Koroner Arter ile Ana Pulmoner Arter Arasında Görülen Fistülün Cerrahi Onarımı: Olgu Sunumu

Öz

Koroner arter fistülleri (KAF) nadir vakalardır. Miyokardiyal iskemi, aritmi, pulmoner hipertansiyon ve kalp yetmezliğine neden olabilirler. Tedavi seçenekleri tartışmalı ve net değildir. Bu yazıda sağ koroner arter fistülü ve eşlik eden koroner arter hastalığı olan bir olgunun cerrahi tedavisini sunuyoruz. Altmış yaşında erkek hasta, stabil anjina semptomları ile tıp merkezimize başvurdu. Koroner anjiyografide, pulmoner artere doğru sağ koroner arter fistülü ve fistülün başlangıcından sonra yer alan belirgin sağ koroner arter lezyonu görüldü. KAF epikardiyal olarak kliplerle ligature edildi ve sağ koroner arter revaskülarizasyonu yapıldı. Koroner arter fistülleri önemli hemodinamik sorunlara neden olur. Cerrahi ve transkateter girişimsel işlemler tedavi seçenekleridir. Bu nedenle bu hastalar için tedavi endikasyonları çok önemlidir. En iyi tedavi stratejisi (cerrahi veya transkateter müdahale) hala net değildir. Özellikle asemptomatik ve küçük fistüllerde cerrahi tedavi tartışmalıdır. Ancak büyük ve semptomatik fistüllerin tedavi edilmesi gerektiği konusunda fikir birliği vardır. Bu gözlemleri derinleştirmek için daha fazla araştırmaya ihtiyaç vardır.

Anahtar Kelimeler

• Koroner arter fistül
• Sağ koroner arter
• Pulmoner arter
• Koroner arter hastalığı

Kaynakça

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