Right coronary artery-coronary sinus fistula diagnosed by three-dimensional echocardiography

Right coronary artery-coronary sinus fistula is a very rare congenital anomaly in which a right coronary artery fistula drains into the right atrium, right ventricle, or pulmonary artery. A right coronary artery-coronary sinus fistula was diagnosed in a 44-year-old man by three-dimensional echocardiography and confirmed by computed tomography angiography and surgery. Relevant published experience in diagnosing this kind of anomaly is summarized.     

彩色多普勒超声诊断右冠状动脉右房瘘合并右房内冠状动脉瘤1例

正患者男,28岁,因心悸于外院超声检查发现右房基底部于上腔静脉入口处见44 mm×41 mm囊性无回声区。经我院心脏超声心动图检查:全心大,右冠状动脉扩张(图1),根部宽约20 mm,自前向后上走行至右房顶部,进入右房内形成局部较大瘤样回声,大小约43 mm×41 mm;CDFI示主动脉内血流自主动脉右窦经右冠状动脉瘘入右房,在右房内形成瘤样扩张,其内形成环状     

彩色多普勒超声心动图对冠状动脉瘘的诊断价值

目的探讨彩色多普勒超声心动图在冠状动脉瘘诊断中的价值。方法回顾分析2004~2009年11例冠状动脉瘘的超声心动图的声像图表现。结果受累冠状动脉明显扩张,11例冠状动脉瘘中,右冠状动脉瘘8例,左冠状动脉瘘3例。结论彩色多普勒超声心动图对冠状动脉瘘的诊断准确、快捷,可作为首选影像学检查方法。     

经胸超声心动图评价先天性冠状动脉瘘

目的探讨经胸超声心动图对先天性冠状动脉瘘病变的诊断价值。方法回顾性分析43例先天性冠状动脉瘘手术病例的经胸超声心动图检查结果,并与手术病理结果相对照,计算超声诊断准确率及瘘管走行、瘘口显示率。结果43例患者包括右冠状动脉瘘21例,左冠状动脉瘘19例及双冠状动脉瘘3例。经胸超声诊断准确率为88.4%。瘘管走行的总显示率为68.2%,其中肺动脉瘘瘘管多细小,其瘘管走行显示率为21.4%,瘘至其他心腔的瘘管走行显示率为92.6%。瘘口的总显示率为86.8%,其中单发瘘口的显示率为96.6%,多发瘘口的显示率为75.0%。先天性冠状动脉瘘超声表现为病变冠状动脉起始段增宽、瘘管走行迂曲扩张并瘘入心腔或大血管、瘘口处异常血流信号等。结论经胸超声心动图可作为无创性诊断先天性冠状动脉瘘的首选方法,但对细小瘘管及多发瘘口仍应建议结合冠状动脉造影检查。     

Prenatal diagnosis of left coronary artery to right ventricle fistula

Prenatal diagnosis of a congenital coronary artery fistula between the left coronary artery and the right ventricle was established at 28 weeks of gestation. Hydrops fetalis developed during follow‐up and the baby died on the first day after delivery. It is rare for coronary artery fistulas to become symptomatic during fetal life. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound, 43 :129–131, 2015     

Prenatal diagnosis of a right coronary artery to right atrial fistula with a giant coronary artery aneurysm: A case report

Coronary artery fistula (CAF) is a rare cardiac anomaly. Here, we diagnosed a right coronary artery-right atrium fistula with giant coronary artery aneurysm (CAA) via fetal echocardiography at 35 weeks' gestation. An urgent caesarean delivery was performed at 36 weeks' gestation because CAA caused mitral obstruction, and fetal atrial flutter was present. Following delivery, we performed aneurysm ligation because the new-born developed atrial tachycardia. The intraoperative findings confirmed the sonographic findings. To the best of our knowledge, prenatal ultrasound diagnosis of CAF and giant CAA has not been reported in the literature. We focus on the ultrasonic characteristics and differential diagnosis in this literature.     

超声心动图评价经导管冠状动脉瘘封堵治疗疗效

目的 探讨超声心动图评价冠状动脉瘘(coronary artery fistula,CAF)经导管封堵治疗疗效的价值.方法 回顾性分析17例CAF患者封堵术前及术后随访的超声心动图资料,观察CAF受累冠状动脉、瘘口的位置和大小等,经导管封堵术后封堵器的位置形态、有无残余分流、房室大小变化等.结果 术前超声心动图检查17例均为单支冠状动脉病变,瘘口大小2～14 mm,平均(6.4±3.5)mm.17例均封堵成功,术后1～4 d超声心动图检查分流消失.随访观察(11.7±7.9)个月,封堵器位置形态正常,无并发症发生,左心室大小恢复正常.结论 CAF经导管封堵治疗是一种微创、安全、疗效确切的方法 ,超声心动图是术前初步筛选及术后随访的主要方法 .

Abstract：

Objective To investigate the efficacy of transcatheter closure of coronary artery fistula (CAF) by transthoracic echocardiography(TTE) and the role of TTE in this therapy. Methods CAF were occluded with transcatheter closure techniques in 17 patients. TTE was performed before and after the treatments. The key points were retrospectively analyzed including: the sites of CAF, the position and diameter of CAF,the shape and position of the devices after the intervention,the residual shunt,and cardiac chamber size. Results Before the therapy,TTE made definite diagnosis of CAF. All patients had lesions in single coronary artery, and the diameter of CAF was 2-14 (6.4 ± 3.5)mm. All patients underwent transcatheter closure successfully. TTE revealed the shunts disappear 1-4 days after the occlusion. During a follow-up period of 1- 29 (11.7± 7.9)months,no residual shunts, no complications, and normal size of thecardiac chambers were recognized by TTE. Conclusions The transcatheter closure of CAF has emerged as a less invasive, safe and effective strategy. Echocardiography has important role in primary screening of patients and the follow-up after the treatments.     

超声心动图诊断左冠状动脉右房瘘5例

【】目的:分析左冠状动脉右房瘘的彩色多普勒超声心动图特征,探讨超声心动图对诊断左冠状动脉右房瘘的价值。方法：应用超声心动图的二维图像、彩色显像和频谱多普勒观察左冠状动脉右房瘘的解剖异常及心腔内异常高速血流。结果：超声心动图均可见解剖异常的左冠状动脉显著扩张,走行迂曲,全程追踪显示瘘管,并于心腔内可见异常双期连续高速分流频谱,与冠状动脉造影及手术结果相符。结论：超声心动图对左冠状动脉右房瘘的诊断有很高直观性及实用性价值     

经胸超声心动图诊断冠状动脉起源异常的临床价值

目的探讨经胸超声心动图(TTE)诊断冠状动脉起源异常(CAOA)的临床应用价值.方法应用TTE对11例CAOA患者进行检查,显示冠状动脉的起源、走行、血流方向、性质、时相和速度,观察有无合并其他心血管畸形,并与冠状动脉造影和手术结果比较.结果左冠状动脉起源于肺动脉5例、起源于右冠状动脉1例,左前降支起源于右冠状动脉1例,疑诊左前降支或左回旋支起源于右冠状动脉窦1例,左前降支和左回旋支单独起源于左冠状动脉窦2例,右冠状动脉高位发出1例.其中合并右冠状动脉-右室瘘1例,卵圆孔未闭1例,二尖瓣前叶夹层动脉瘤形成伴破裂1例,继发性心内膜弹力纤维增生症3例.超声结果与冠状动脉造影和手术结果符合.结论经胸超声心动图能准确提供冠状动脉的起源、走行、血流状态等信息,具有重要的临床应用价值.     

A case of coronary artery fistula with mitral stenosis

Coronary artery fistulae, being a rare form of congenital anomalies of the coronary arteries, are usually discovered by chance during coronary arteriography. However, these fistulae can cause an important coronary morbidity and mortality leading to angina, syncope, congestive heart failure, myocardial infarction and sudden death. The coincidence of mitral stenosis and congenital artery fistula is rare in the literature. In our case report, a patient with a coronary artery fistula originating from the circumflex, draining to the main pulmonary artery, discovered at cardiac catheterization and coronary angiography done with a prediagnosis of mitral stenosis is presented in the light of the literature.     

二维斑点追踪技术评估合并右冠状动脉狭窄的冠心病患者右室功能的研究

目的 探讨二维斑点追踪技术(two-dimensional speckle tracking echocardiography 2D-STE)在评估合并右冠状动脉狭窄的冠心病 (coronary artery disease, CAD)患者右室功能改变中的价值。方法 拟诊为冠心病的患者137例,进行常规超声心动图及组织多普勒超声检查。使用2D-STE测量右室游离壁整体峰值纵向应变(global longitudinal peak strain, GLS)、游离壁及室间隔侧基底段、中间段及心尖段收缩期纵向峰值应变(longitudinal peak systolic strain, ε)、右室收缩期峰值应变率(peak systolic strain rate, SRs)、舒张早期峰值应变率(peak early diastolic strain rate, SRe)及舒张晚期峰值应变率(peak late diastolic strain rate, SRa)。根据冠脉造影结果及是否合并右冠状动脉狭窄,分为对照组(A组,冠脉狭窄＜50%)、冠心病不合并右冠状动脉狭窄组(B组)及冠心病合并右冠状动脉狭窄组(C组)。结果 三组间RVFAC、TAPSE、LVEF、SV、S’、Em、Am方面比较,差异无统计学意义(P＞0.05)。三组间游离壁侧基底段ε、中间段ε、心尖段ε、游离壁GLS及SRs方面比较,差异均有统计学意义(P＜0.05)。A组与B组在室间隔侧基底段ε及中间段ε比较差异无统计学意义(P＞0.05)。与B组相比,C组的室间隔侧基底段ε及中间段ε减低(P＜0.05)。三组间SRe、SRa及室间隔侧心尖段ε比较无统计学差异(P＞0.05)。结论 合并右冠状动脉狭窄的冠心病患者右室收缩功能已发生亚临床改变,2D-STE可有效评估右室功能障碍,为临床冠心病患者右室功能的早期诊断及预后提供新的参考价值。     

A case of coronary-pulmonary artery fistula with coronary artery aneurysm detected for Kawasaki disease remote phase

Follow-up echocardiography showed two coronary-pulmonary artery fistulae and a coronary artery aneurysm in a 12-year-old boy who had been diagnosed with Kawasaki disease without persistent coronary artery lesion at the acute phase when he was 6-months-old. Left coronary arteriogram confirmed the fistulae and the 4.3 × 6.3 mm aneurysm. Results show that the fistula is associated with Kawasaki disease.     

彩色多普勒超声心动图诊断冠状动脉瘘的价值

目的：探讨各类型冠状动脉瘘（CAF）的彩色多普勒超声心动图（CDE）图像特征及超声心动图诊断CAF的价值。方法：对11例CAF患儿进行回顾性分析，寻找CAF图像特征及规律性。结果：根据CDE图像特征对11例患儿作出正确诊断。CAF的CDE具有明显的图像特征：①在瘘入的心腔或肺动脉内彩色多普勒血流显像（CDFI）显示异常血流束信号；②瘘的冠状动脉明显扩张；③右冠状动脉瘘多见，瘘入右心系统者最常见；④瘘入右房、右室、左房、肺动脉时均为双期连续湍流频谱，瘘入左室时为舒张期湍流频谱。结论：CDE对CAF的诊断有很高的价值。     

Anomalous origin of the right coronary artery mimicking aortic dissection at transesophageal echocardiography

Transesophageal echocardiography (TEE) is the most common imaging modality for the detection of acute aortic syndromes. However anomalous anatomic structures may be occasionally misunderstood as pathologic due of lack of familiarity with anatomical variations; false-positive diagnosis can result, potentially leading to unnecessary surgical intervention. It is crucial for echocardiographers to be aware of possible pitfalls which may create false positive findings, since the complementary use of other imaging modalities, such as multislice spiral computed tomography (MSCT), could improve the diagnostic accuracy of TEE. We report a case in which an image resembling an acute aortic dissection (AAD) on transthoracic (TTE) and transesophageal echocardiography was found in a patient with acute chest pain; MSCT detected an anomalous origin of the right coronary artery as cause of false aortic dissection image at echocardiography.     

右冠状动脉右房瘘并冠状动脉瘤1例

患者男,45岁。劳累后心悸、气短9个月,近1周逐渐出现咳嗽、夜间不能平卧及颜面浮肿。查体:一般状态尚可,血压110/160mmHg。心界向左下扩大,胸骨左缘第2、3肋间闻及双期连续性杂音,肺动脉第二音亢进。双侧股动脉枪击音及毛细血管征阳性。胸片:心脏呈主动脉瓣型,心胸比率为0.68,左心室段延长,心尖饱满、圆钝。右前斜吞钡食管中段未见受压移位改变,左前斜位片见心前缘上部呈半圆形状突出(图1)。心电图示:右心室肥厚。心脏彩超:右冠状动脉起始处呈瘤样扩张,开口处内径22mm,向外走行瘤体内径54mm,范围67mm,向右呈管状结构纡曲走行,远侧内径为13m…     

胎儿冠状动脉瘘的超声心动图评价

目的通过回顾性分析胎儿冠状动脉瘘的超声图像特征,探讨超声心动图在胎儿冠状动脉瘘诊断中的价值。 方法选取2016年1月至2017年12月在武汉协和医院行产前超声心动图检查诊断为冠状动脉瘘的胎儿9例,对其二维超声图像、彩色多普勒图像、血流频谱特征及其合并畸形情况进行分析,其中5例与出生后超声诊断结果或引产后尸检结果进行对照。 结果产前超声心动图诊断为冠状动脉瘘的9例胎儿,均可观察到受累冠状动脉扩张,彩色多普勒血流成像（CDFI）可显示冠状动脉瘘管的起源、走行、内径、血流情况及瘘入部位,频谱多普勒可探及瘘管内特征性血流频谱。9例胎儿中,2例出生后经超声心动图检查确诊为冠状动脉瘘,3例引产后尸检证实为冠状动脉瘘,4例引产后未行尸检。 结论胎儿冠状动脉瘘的超声心动图具有特征性改变,产前正确诊断胎儿冠状动脉瘘对评估胎儿预后及早期治疗有重要意义。     

Congenital absence of the right coronary artery: A case report

BACKGROUNDAs a rare anomaly, congenital absence of the right coronary artery (RCA) occurs during the development of coronary artery. Patients with congenital absence of the RCA often show no clinical symptoms, and this disease is considered benign. The left coronary artery gives blood supply to the whole myocardium. The prevalence of congenital absence of the RCA is approximately 0.024%-0.066%. There are few cases reported as for this disease. In this work, a patient, with congenital absence of the RCA diagnosed by coronary angiography (CAG), was described. CASE SUMMARYA 41-year-old man arrived at our hospital for treatment, due to the repeated palpitations for a duration of one year. Considering the possibility of coronary heart disease, the patient underwent CAG that indicated the congenital absence of the RCA. Unfortunately, the patient refused to accept computed tomography coronary angiography (CTCA), to further confirm the congenital absence of the RCA.CONCLUSIONSingle coronary artery is a rare type of coronary artery abnormality, which usually has no obvious clinical manifestations and is considered as a benign disease. CAG is the main means by which congenital absence of the RCA can be diagnosed, and the disease can also be further confirmed by CTCA.     

Left anterior descending artery occlusion secondary to blunt chest trauma diagnosed by comprehensive echocardiography and coronary angiography

Blunt chest trauma can cause serious complications, but coronary artery occlusion is rare. In a 19-year-old man, 40 days after a motorcycle accident, comprehensive echocardiography detected left anterior descending artery occlusion and left ventricular dysfunction, which was confirmed by coronary angiography and ventriculography. Echocardiography was also able to confirm restored left anterior descending artery flow and improved left ventricular function after coronary artery bypass grafting.