Mustafa PAÇ, Serhat KOCA, Ahmet Vedat KAVURT, Ajda Mutlu MIHÇIOĞLU, Feyza Ayşenur PAÇ

Koroner arter anomalisi olan hastaların değerlendirilmesi

Amaç: Bu çalışmada koroner arter fistülü, pulmoner arterden sol koroner arterin anormal çıkışı ve pulmoner arterden sağ koroner arterin anormal çıkışı olan hastalar değerlendirildi. Çalışma planı: Ocak 2009 - Mart 2015 tarihleri arasında koroner arter fistülü, pulmoner arterden sol koroner arterin anormal çıkışı ve pulmoner arterden sağ koroner arterin anormal çıkışı ile pediatrik kardiyoloji kliniğine sevk edilen 14 hasta retrospektif olarak değerlendirildi. Koroner arter fistülü olan 10 hasta grup 1 ve pulmoner arterden sol koroner arterin anormal çıkışı ve pulmoner arterden sağ koroner arterin anormal çıkışı olan dört hasta grup 2 olarak sınıflandırıldı. Hastaların çoğu fizik muayenede üfürüm ile birlikte göğüs ağrısı nedeniyle değerlendirildi. Üç hastaya transkateter ve bir hastaya cerrahi işlem uygulandı. Cerrahi gereken bir hasta tedaviyi kabul etmedi ve herhangi bir girişime gerek görülmeyen diğer beş hasta ile birlikte ayaktan takibe alındı. Grup 2’deki hastalara cerrahi yapıldı. Bulgular: Tedavi uygulanan hastalar sorunsuz olarak hastaneden taburcu edildi. Grup 1’deki hastalara girişim sonrası asetilsalisilik asit verildi. Bir hastaya, sağ koroner arter proksimalinde devam eden dilatasyon nedeniyle varfarin de verildi. Grup 2’deki hastaların takibinde klinik bulgularda düzelme saptandı. Sonuç: Koroner arter fistülleri, pulmoner arterden sol koroner arterin anormal çıkışı ve pulmoner arterden sağ koroner arterin anormal çıkışı ekokardiyografik değerlendirme sırasında kolaylıkla gözden kaçabilmektedir. Bu nedenle, ileri görüntüleme yöntemleri gerekebilmektedir. Fistül tedavisinde transkateter tedavi, cerrahi tedaviye güvenilir bir alternatiftir. Pulmoner arterden sol koroner arterin anormal çıkışı ve pulmoner arterden sağ koroner arterin anormal çıkışı cerrahisinde arteriyel reimplantasyon tekniği başarılıdır. Ekokardiyografi, bu nadir, ancak önemli hastalıkların belirlenmesinde esas rolü üstlenmektedir.

Evaluation of patients with coronary artery anomalies

Background: This study aims to evaluate patients with coronary artery fistulas, anomalous origin of left coronary from pulmonary artery, and anomalous origin of right coronary artery from pulmonary artery.Methods: Fourteen patients who were referred to pediatric cardiology clinic with a coronary artery fistula, anomalous origin of left coronary from pulmonary artery, and anomalous origin of right coronary artery from pulmonary artery between January 2009 and March 2015 were retrospectively analyzed. Ten patients with a coronary artery fistula were grouped as group 1, and four patients with anomalous origin of left coronary from pulmonary artery and anomalous origin of right coronary artery from pulmonary artery as group 2. Most of the patients were evaluated for chest pain with murmur on physical examination. Three patients underwent transcatheter and one patient surgical procedure. One patient indicated for surgery did not accept treatment and was followed in the outpatient setting with the other five patients who did not need any intervention. Patients in group 2 underwent surgery.Results: The patients who underwent treatment were discharged from hospital without any problem. Acetylsalicylic acid was given to the patients in group 1 following the intervention. One patient used also warfarin for persistent dilatation of the proximal right coronary artery. Group 2 patients had improved clinical findings during follow-up.Conclusion: Coronary artery fistulas, anomalous origin of left coronary from pulmonary artery, and anomalous origin of right coronary artery from pulmonary artery can be easily overlooked during echocardiographic evaluation. Therefore, further imaging modalities may be needed. Transcatheter approach is a safe alternative to surgical therapy in the treatment of fistulas. Arterial reimplantation technique is successful in anomalous origin of left coronary artery from pulmonary artery and anomalous origin of right coronary artery from pulmonary artery surgery. Echocardiography has the main role in identifying these rare, but critical conditions.

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