右冠状动脉-左心室瘘合并巨大右冠状动脉瘤诊治一例

正1临床资料患者,男性,40岁。因"体检发现心脏杂音30年,活动后气促1年"入院。查体:血压130/60 mm Hg(1 mm Hg=0.133 k Pa),心前区可见抬举性搏动,心界叩诊向左下扩大,心率76次/min,律齐,胸骨左缘第2、3肋间可闻及舒张期杂音。心电图示:窦性心律,左心室肥厚伴ST-T改变。超声心动图示(图1):左心室射血分数50%,全心扩大,左心室为主(左心室舒张末期     

右冠状动脉左心室瘘一例

右冠状动脉左心室瘘一例中日友好医院心血管外科叶志东张伟刘鹏林凡王凤林１临床资料患者男性，３６岁。劳累后心悸、气短两年就诊。查体：血压１８．０／９．２ｋＰａ（１３５／６９ｍｍＨｇ），胸骨左缘第３肋间和第４肋间，可闻及中度哈气样舒张期杂音，剑突下最明显...     

右冠状动脉-左心室瘘一例

1 临床资料 患者，男性，9岁。发现心脏杂音1年入院。体检：一般情况可，心界向左下扩大。胸骨左缘第4、5肋间闻及3／6级粗糙舒张期杂音；心电图示窦性心律，双室增大；X线胸片示肺野清晰，主动脉结缩小，左心缘饱满并向左侧扩大；心脏彩色超声心动图示右冠状窦扩张（开口14mm），右冠状动脉增宽。走行迂曲。沿右侧房室沟下行。于左室下壁二尖瓣后叶后方引流入芹审（开口14mm）；冠状动脉造影昆示（网1）：右冠状动脉明显迂曲。增粗，直径超过10mm，与左心室相接，瘘管中途未见明显分支显示。全麻体外循环下手术。术中探查见：右冠状动脉增粗，直径12mm左右，于心室下壁右冠状动脉末端可触及连续性震颤。瘘管中途可见3支冠状动脉分支，建立体外循环后。于心室下壁右冠状动脉末端剪开右冠状动脉，     

超声心动图诊断右冠状动脉左心室瘘一例

正1临床资料患者男,34岁,既往体健。因查体发现心脏杂音10天入院。阳性体征为心尖区可闻及舒张期隆隆样杂音。心电图:窦性心律;Ⅰ、Ⅱ、aVF导联ST段压低,T波倒置。X线胸片:心影增大。超声心动图:左心室系统增大,主动脉右冠窦及右冠状动脉扩张,绕冠状沟走行至后方,开口于左心室二尖瓣后叶瓣根部下方(图1)。左心室内见舒张期五彩分流血流束(图2)。诊断:右冠状动脉左心室瘘。冠状动脉造影:右冠状动脉主干显著扩张,并于后室间支中下部汇入左心室,右冠状动脉各分支纤细。术中所见同术前超声和造影诊断一致。     

右冠状动脉-左心室瘘1例

患者,女,28岁。因体检发现心脏杂音而于2002年入院。     

右冠状动脉-左心室瘘合并二尖瓣腱索断裂、脱垂一例

患者,女,49岁,1周前无明显诱因出现胸闷气短、心悸乏力,伴有夜间端坐呼吸,休息后可逐渐缓解。双下肢水肿。二尖瓣听诊区可闻及4/6级收缩期吹风样杂音。心电图提示：心电轴左偏,心房颤动,心室率85次/分,部分导联ST-T改变。超声心电图提示：二尖瓣后叶脱垂、断裂并重度反流;左心系统扩大,左心室射血分数约60%;中度肺动脉高压。纽约心脏协会（NYHA）心功能Ⅲ～Ⅳ级。入院后给予对症处理后择期手术。术前常规行冠状动脉造影（冠造）检查。     

冠状动脉左心室瘘一例

<正>1临床资料患者男性,67岁,主因"咽部堵塞感2个月"于2009年2月17日入院。患者2个月前无诱因突发咽部堵塞感,呕吐,伴意识不清,无胸闷、胸痛症状,就诊当地医院。心电图检查     

巨大右冠状动脉瘤1例

正巨大冠状动脉瘤(直径大于20mm)是一种罕见的疾病,患病率为0.02%,是冠状动脉瘤样扩张较为罕见的一种类型[1]。目前指南认为手术切除可能是有潜在生命危险如破裂、血栓和远端冠状动脉栓塞等患者的最佳选择[2]。巨大冠状动脉瘤发病隐匿,症状不典型,一旦造成心肌梗死等严重并发症,病死率高,因此早期诊断尤其重要[3]。本文通过1例典型病例报道,就近年来该病的流行病学、病因、临床表现与最新诊断及治疗进展作一     

先天性右冠状动脉窦瘤伴右冠状动脉—左室瘘一例

患者,男,28岁。因体检发现心脏杂音10年,阵发性头晕2年,于1989年10月6日入院。检查:BP15.9/6.1kPa(120/46mmHg)。无紫绀及颈静脉怒张,肝颈静脉返流征(-),颈动脉搏动稍增强。双肺无异常。心界向左下稍扩大,HR68次/分,律齐,P_2>A_2。胸骨左缘Ⅱ～Ⅴ肋间可闻及泼水样舒张期杂音,以Ⅲ～Ⅳ肋间最响。水冲脉(+),毛细血管搏动征(+)。肝脾未扪及,无浮肿。ECG示:     

Single left coronary artery with microfistula communicating with the left ventricle: a case report

A 79-year-old man with lung cancer undergoing chemotherapy and radiation complained of chest pain. Coronary angiography revealed that the right coronary artery arose from the distal branch of the left circumflex artery. In addition, a left coronary artery-to-left ventricular microfistula was recognized coincidentally. Multidetector row computed tomography revealed no other cardiac anomalies besides the single left coronary artery. No evidence of ischemia was noted during exercise stress myocardial scintigraphy. No vasospasm provocation study was performed, as it was considered to be potentially life-threatening for a patient with the single coronary system. In general, single coronary artery may occasionally represent a potentially fatal condition, so careful attention must be paid to its anatomical features.     

Bilateral coronary artery fistulas communicating with main pulmonary artery and left ventricle: case report

Coronary artery fistula is an uncommon congenital malformation that generally drains into the main pulmonary artery or the right side of the heart. This is a case report on bilateral coronary artery fistulas communicating with the main pulmonary artery and the left ventricle. A 65-year-old woman was investigated for recurrent chest pain. Coronary angiography revealed this anomalous coronary artery connection without evidence of atherosclerotic coronary artery disease. The rarity of coronary artery fistulas involving both the main pulmonary artery and the left ventricle is emphasized.     

Multiple coronary artery fistulae communicating through a sinusoid and emptying into the left ventricle

This case report describes the occurrence of multiple coronary artery fistulae emptying into the left ventricle and includes a small communication into the left atrium. The initial diagnosis of a coronary artery fistula was made by standard and nonstandard transthoracic two-dimensional echocardiogram and Doppler interrogation. Later, multiple coronary fistulae communicating through a sinusoid and draining into the left-sided chambers were confirmed by angiography.     

Right coronary artery to left ventricle fistula associated with three-vessel coronary artery disease: a case report

Right coronary artery to left ventricle fistula is a rare type of coronary artery fistula among congenital coronary artery anomalies. Most patients exhibit no symptoms and some experience chest pain. Coronary angiography sometimes detects the presence of coronary artery fistula, but not coronary arteriosclerosis. A 76-year-old man with unstable angina was admitted because he did not respond to drug therapy. Coronary angiography showed three-vessel coronary artery disease and the contrast agent entered the left ventricle from the terminal of the right coronary artery during diastole. Multidetector-row computer tomography showed similar findings. The patient subsequently underwent coronary artery bypass grafting and obliteration of the coronary artery fistula. The chest pain was relieved and he is now in good condition.     

Noninvasive diagnosis of left coronary arteriovenous fistula communicating with the right ventricle

In a 20 year old man, the diagnosis of a left coronary arteriovenous fistula communicating with the right ventricle was made by noninvasive techniques using M mode, two dimensional and Doppler echocardiography. The diagnosis was confirmed by coronary angiography.     

高龄左右冠状动脉-左心室瘘一例

患者女性,77岁,因"活动后胸闷、胸痛1年余,加重3天"于2008年4月入院.近1年活动耐力下降,快步行走后即感胸闷、气促.患者有心律失常(频发房性早搏、窒性早搏)史10余年.     

高龄左右冠状动脉-左心室瘘一例

患者女性,77岁,因"活动后胸闷、胸痛1年余,加重3天"于2008年4月入院.近1年活动耐力下降,快步行走后即感胸闷、气促.患者有心律失常(频发房性早搏、窒性早搏)史10余年.     

高龄左右冠状动脉-左心室瘘一例

患者女性,77岁,因"活动后胸闷、胸痛1年余,加重3天"于2008年4月入院.近1年活动耐力下降,快步行走后即感胸闷、气促.患者有心律失常(频发房性早搏、窒性早搏)史10余年.     

高龄左右冠状动脉-左心室瘘一例

患者女性,77岁,因"活动后胸闷、胸痛1年余,加重3天"于2008年4月入院.近1年活动耐力下降,快步行走后即感胸闷、气促.患者有心律失常(频发房性早搏、窒性早搏)史10余年.