双侧冠状动脉-肺动脉瘘误诊为冠状动脉粥样硬化性心脏病

Bilateral Coronary Artery-Pulmonary Artery Fistula Misdiagnosed as Coronary Atherosclerotic Heart Disease

目的提高对成年人双侧冠状动脉瘘(coronary artery fistulas,CAF)临床特点的认识,减少误诊误治。方法回顾性分析1例双侧冠状动脉-肺动脉瘘的临床资料,并复习相关文献。结果患者表现为间断胸闷、气短3年,休息或服用速效救心丸后可缓解。本次因加重2 d入院,心电图提示窦性心动过缓、多发室性早搏,入院诊断为冠状动脉粥样硬化性心脏病(冠心病)心绞痛,予硝酸酯类治疗无缓解。冠状动脉造影检查提示各分支无狭窄,前降支及右冠状动脉近端发出异常血管至肺动脉。确诊为双侧冠状动脉-肺动脉瘘。结论双侧CAF的临床表现不典型,易被误诊为冠心病、动脉导管未闭,冠状动脉造影能够协助其诊断。

Objective To enhance the understanding of clinical characteristics of bilateral coronary artery fistulas （CAF） in adults to avoid the misdiagnosis and mistreatment. Methods Clinical data of one patient with bilateral coronary -pulmonary fis- tula was retrospectively analyzed, and related literature was reviewed. Results The patient suffered from intermittent dyspnea and short breath for three years, and the symptoms were relieved after having a good rest or taking Suxiaojiuxin pills. The patient was admitted for pathogenetic condition aggravation for 2 d, and electrocardiogram showed sinus bradycardia and frequent ventricular premature beat （FVPB）. The patient was diagnosed as having coronary atherosclerotic heart disease of angina pectoris after admis- sion, and failed to response to nitrates therapy. Coronary angiography （CAG） showed that there was no stenosis of the artery bran- ches, and there were two abnormal vessels from anterior descending branch and the proximal portion of right coronary artery （RCA） to pulmonary artery. The patient was confirmed as having bilateral coronary-pulmonary fistula. Conclusion The clinical manifesta- tions of bilateral coronary artery fistulas are atypical, and it can be easily misdiagnosed as coronary heart disease or patent ductus ar- teriosus （PDA）. Coronary angiography may be helpful in diagnosis.