冠状动脉瘘(CAFs)代表冠状动脉和另一个冠状动脉之间的异常连接的频谱,静脉,或主要血管,被称为冠状动脉血管瘘,或者在冠状动脉和心腔之间,称为冠状动脉瘘。虽然CAF通常在成年后的第五个十年内保持无症状,它们可以表现出不同的症状,通常是心肌灌注异常引起的心绞痛,或者在较大的瘘管中,如肺或左心室循环超负荷引起的右心或左心衰竭。在瘘内没有血栓形成的情况下,CAF很少表现为心肌梗塞。当根据体格检查的持续杂音或放射学的意外发现临床怀疑时,计算机断层扫描血管造影(CTA)和冠状动脉血管造影是首选的诊断成像方式.瘘管解剖和患者特定特征指导经导管或手术管理策略的临床决策。我们介绍了右冠状动脉上腔静脉瘘,表现为非ST段抬高型心肌梗死。我们还对可用于评估CAF的成像技术进行了综述,以及关于CAF诊断和管理的主要国家和国际心脏病学会指南的摘要。
Coronary artery fistulas (CAFs) represent a spectrum of abnormal connections between a coronary artery and another coronary artery, vein, or major blood vessel, known as coronary-vascular fistulas, or between a coronary artery and a cardiac chamber, known as coronary-cameral fistulas. While CAFs generally remain asymptomatic into the fifth decade of adult life, they can present with a diverse symptomatic profile, typically with angina from abnormal myocardial perfusion, or in the setting of larger fistulas, as right- or left-heart failure from pulmonary or left ventricular circulatory overload. CAFs rarely manifest as myocardial infarction in the absence of thrombosis within the fistula. When clinically suspected based on a continuous murmur on physical exam or an accidental finding on radiology, computed tomography angiography (CTA) and coronary angiography are the preferred diagnostic imaging modalities. Fistula anatomic and patient specific characteristics guide clinical decisions on transcatheter or surgical management strategies. We present the case of a right coronary artery-superior vena cava fistula manifesting as a non-ST elevation myocardial infarction. We also present a review of the imaging techniques available for evaluation of CAFs, and a summary of the major national and international cardiology society
guidelines on the diagnosis and management of CAFs.