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題名 | Bilateral Coronary Artery Fistulae with a Giant Aneurysm Associated with Ventricular Tachycardia--A Case Report=與心室頻脈並存之兩側冠狀動脈瘻管合併一巨大冠狀動脈瘤--一病例報告 |
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作者 | 郭任遠; 周友三; 蔡正河; 聶梅珍; 吳再成; | 書刊名 | Acta Cardiologica Sinica |
卷期 | 14:1 民87.01-03 |
頁次 | 頁28-34 |
分類號 | 415.3161 |
關鍵詞 | 兩側; 冠狀動脈瘻管; 經食道超音波心圖; 心室頻脈; 心臟電生理檢查; Bilateral; Coronary artery fistula; Transesophageal echocardiogram; Ventricular tachycardia; Electrophysiological study; |
語文 | 英文(English) |
中文摘要 | 背景:冠狀動脈□管乃一不常見之異常,其為冠狀動脈與心臟腔室、靜脈或其他動脈間發生交通。兩側冠狀動脈□管與心室頻脈並存的,臨床上頗為罕見,從1966年迄今,文獻上僅有三病例報告。 方法與結果:本文報告一位七十四歲男性病人,發生兩側冠狀動脈□管合併一巨大冠狀動脈瘤,臨床上以心室頻脈來表現,經食道超音波心圖顯示左及右冠狀動脈擴大、主動脈左側有數個圓形無回音之區域、彩色血流訊號充滿其間,並見二個圓形無回音區域與肺動脈主幹有血流相通。冠狀動脈攝影證實為上述診斷。術前建議病患作心臟電生理檢查以確實明瞭心室頻脈之機轉,並為適當治療,但為病患所拒。手術後,病患仍見數次非持續性心室頻脈,在十個月後發生猝死。 結論:對一個以心室頻脈呈現之兩側冠狀動脈□管病人,手術前作心臟電生理檢查以評估及治療其心室頻脈是必要的。 |
英文摘要 | Background. Coronary artery fistula is an unusual anomaly which consists of a communication between one of the coronary arteries and a cardiac chamber, artery or vein. Bilateral coronary artery fistulae presenting with ventricular tachycardia (VT) are rare. Only three similar cases have been reported in the literature since 1966. Methods and Results. A 74-year-old male presenting with VT had bilateral coronary artery fistulas, with a giant aneurysm. Transesophageal echocardiogram (TEE) revealed dilated proximal left and right coronary arteries, several round echo-free areas at the left side of the aorta, with color flow signals in the left and right coronary arteries and each of the round echo-free areas. The pulmonary main trunk was connected with two of the echo-free areas during systole and diastole. These findings were confirmed by coronary angiography. Electrophysiological study, suggested preoperatively to evaluate the ventricular tachycardia, was refused by both patient and family. Surgical correction was perfomed and postoperatively the patient still had several episodes of non-sustained ventricular tachycardia. Ten months later, he suffered sudden death, most likely secondary to ventricular arrhythmia. Conclusion. For a patient with bilateral coronary artery fistulae presenting with VT, preoperative electrophysiological study is highly recommended for the evaluation and management of VT. |
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