関連する実験動画

Updated: Jan 31, 2026

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA

Published on: April 24, 2017

両側性心外膜冠状動脈微小瘻孔と異常偏位

João Cleriston da Silva Calheiros¹, João Pedro Kern Alves², Natan Lucca Lima²

¹Department of Medical Sciences, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil; University of the Extreme South of Santa Catarina, Criciúma, Santa Catarina, Brazil; Department of Cardiology, São José Hospital, Criciúma, Santa Catarina, Brazil; Emergency Department, São João Batista Hospital, Criciúma, Santa Catarina, Brazil.

JACC. Case reports

|January 30, 2026

要旨

Background:

Bilateral coronary microfistulas with redirection to the left ventricle are extremely rare clinical events. Although most cases are asymptomatic, the severity varies according to the redirection of blood flow, possibly leading to type 2 myocardial infarction.

Case Summary:

A 79-year-old woman with a medical history of hypertension, type 2 diabetes mellitus, hypothyroidism, and anxiety presented with atypical chest pain. Electrocardiogram revealed sinus rhythm with an electrically inactive area in the inferior wall, and serial troponin measurements indicated myocardial injury. Coronary angiography demonstrated bilateral coronary microfistulas draining into the left ventricle, in the absence of obstructive coronary artery disease. The patient was discharged with atenolol and acetylsalicylic acid and remained stable during follow-up.

Discussion:

This case contributes to the growing recognition of coronary microfistulas as a rare but clinically meaningful cause of type 2 myocardial infarction, emphasizing the diagnostic value of coronary angiography and reinforcing the importance of individualized conservative management in such diffuse presentations of fistulas.

キーワード:

症例報告冠動脈瘻冠血管奇形微小瘻孔

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