[Surgical treatment of coronary artery to pulmonary artery fistula with a saccular aneurysm].

IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Giornale italiano di cardiologia Pub Date : 2024-06-01 DOI:10.1714/4287.42691
Gerardo Musuraca, Cristiana Giovanelli, Clotilde Terraneo, Nicola Osti, Alessandro Motta, Carlo Angheben, Remo Albiero
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Abstract

A 60-year-old man with hypercholesterolemia and hypertension presented with acute coronary syndrome (SCA). The ECG showed lateral ischemia (T-wave inversion in V4-V6, D1 and aVL) and echocardiography showed normal left ventricular wall motion. Coronary angiography showed critical atherosclerotic lesions in the distal part of the left circumflex artery (LCx, culprit lesion), chronic total occlusion of the right coronary artery (RCA), significant but not critical stenosis in the middle part of left anterior descending artery (LAD), and a coronary artery to pulmonary artery (PA) fistula originating from the proximal part of the LAD and emptying into the PA via a coronary saccular aneurysm (12 x 12 x 10 mm). A multidetector row computed tomography angiography (CTA) confirmed the coronary artery fistula, which was treated with surgical approach. The patient underwent aneurysmorrhaphy with CAF closure and coronary artery bypass grafting on the RCA and LCx. The postoperative course was uneventful and the patient was discharged on postoperative day 14. CTA was useful for understanding the spatial relation of the CAF and the connection with the PA.

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[伴有囊状动脉瘤的冠状动脉至肺动脉瘘的手术治疗]。
一名患有高胆固醇血症和高血压的 60 岁男子出现急性冠状动脉综合征(SCA)。心电图显示侧壁缺血(V4-V6、D1和aVL出现T波倒置),超声心动图显示左心室壁运动正常。冠状动脉造影显示左侧环状动脉(LCx,罪魁祸首)远端存在严重的动脉粥样硬化病变,右侧冠状动脉(RCA)慢性全闭塞、左前降支动脉(LAD)中段有明显但非严重狭窄,冠状动脉至肺动脉(PA)瘘源于左前降支动脉近端,通过冠状动脉囊状动脉瘤(12 x 12 x 10 毫米)流入肺动脉。多切面行计算机断层扫描血管造影术(CTA)证实了冠状动脉瘘,并采用手术方法进行了治疗。患者接受了动脉瘤夹闭术,并在 RCA 和 LCx 上进行了冠状动脉搭桥术。术后过程顺利,患者于术后第14天出院。CTA 有助于了解 CAF 的空间关系以及与 PA 的连接。
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Giornale italiano di cardiologia
Giornale italiano di cardiologia CARDIAC & CARDIOVASCULAR SYSTEMS-
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