Atac CELİK, Metin KARAYAKALİ, Fatih KOC, Koksal CEYHAN, Hasan KADİ

Bilateral Coronary Artery-Pulmonary Artery Fistulas Presenting With Acute Coronary Syndrome

Altmış altı yaşında bayan hasta göğüs ağrısı şikayetiyle kliniğimize sevk edildi. Değerlendirilme sonrası ST yükselmesiz myokard enfarktüsü tanısıyla koroner anjiyografisi planlandı. Transtorasik ekokardiyografi sonrası koroner arter ile pulmoner arter arasında fistül görüntüsü izlenmedi. Koroner anjiyografide distal sol ön inen arter, diyagonal dalı ve obtus marjin dalında kritik darlıklar tespit edildi. Ayrıca, hem sol ön inen arterden hem de sağ koroner arterden köken alıp pulmoner arter ile birleşen 2 fistül izlendi. Myokard sintigrafisi ile sağ koroner artere ait perfüzyon defekti izlenmedi. Distal sol ön inen arterin darlık sonrası lümen çapı küçük olması ve anjiyografi sonrası yapılan ekokardiyografide şant oranının düşük (Qp/Qs: 1.1) olmasından dolayı tıbbi tedaviye karar verildi

Anahtar Kelimeler:

Akut koroner sendrom, koroner anjiyografi, fistül

Bilateral Coronary Artery-Pulmonary Artery Fistulas Presenting With Acute Coronary Syndrome

A 66 year old woman was admitted to other hospital suffering from chest pain. After the treatment as non-ST elevation myocardial infarction, she was transferred to our clinic for angiographic evaluation. There was no evidence of reminiscent coronary artery-pulmonary artery fistula on transthoracic echocardiography. Coronary angiography showed significant stenosis at distal left anterior descending artery (LAD), its diagonal branch, and first obtus marginus. Two fistulas originating from LAD and RCA and join to pulmonary artery were seen in angiographic scenes. No ischemia was seen in RCA perfusion zone by myocardial scintigraphy. Because of the small lumen diameter of the distal LAD and mild shunt ratio (Qp/Qs:1.1) calculated with second echocardiographic examination after angiography, medical therapy was the final choice of treatment.

Keywords:

Acute coronary syndrome, coronary angiography, fistula,

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