Miyokardiyal İskemi Oluşturan ve Sol Ventrikülografiyi Taklit Eden Kalıcı Tebesian Venlerin Ciddi Formu

Koroner arter fistülü nadir bir konjenital anomalidir. Hastaların çoğu asemptomatik olmakla birlikte bazı hastalar semptomatik olabilmekte ve miyokardiyal iskemi, tromboz ve emboli, kalp yetmezliği ve aritmilerle gelebilmektedir. yazımızda efor dispnesi ve anginası bulunan ve miyokard perfüzyon sintigrafisinde geri dönüşlü inferior ve apikal defekt satanan 70 yaşında erkek sunulmuştur. Koroner anjiografide koroner darlık saptanmadı ancak sol ön inen arter, sirkümfleks arter ve sağ koroner arterden çoklu mikrofistüller aracılığıyla sol ventriküler kaviteye boşalan ve sol ventrikülografi görüntüsü oluşturan kapiller boyanma izlendi. Küçük mikrofistüllerden dolayı hastaya medikal tedavi verildi, beta bloker, aspirin ve ranolazin tedavisi ile taburcu edildi. Bir ay sonraki kontrolde hasta yakınmalarında azalma olduğunu belirtti.

Anahtar Kelimeler:

Tebesian ven, koroner arter fistülü, miyokardiyal iskemi

Severe Form of Persistent Thebesian Veins Mimicking Left Ventriculography Presenting with Myocardial Ischemia

Coronary artery fistula is a rare congenital anomaly. Most patients with this anomaly are asymtomatic, but some patients may be symtomatic and have a presentation of myocardial ischemia, thrombosis and embolism, heart failure, arrhytmias. We present a 70-year-old male with exertional dyspnea and angina whose myocardial perfusion scintigraphy demonstrated inferior and apikal defect with complete reversibility. Coronary angiograpyh showed no coronary stenosis, but capillary blush draining into the left ventricular cavity through multiple microfistulas from the left anterior descending artery, circumflex artery and right coronary artery mimicking left ventriculography. Because of these small microfistulas, patient managed medically, he was discharged on a beta blocker, aspirin and ranolazine therapy. He stated a reduction in his symptoms one month later.

Keywords:

Thebesian veins, coronary artery fistula, myocardial ischemia,

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