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英文誌(2004-)

Journal of Medical Ultrasonics

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1998 - Vol.25

Vol.25 No.01

Original Article(原著)

(0041 - 0046)

成人の冠状動脈瘻診断に対する心エコー図の果たす役割

Role of Echocardiography in Diagnosing Coronary Artery Fistula

伊賀 幹二1, 泉 知里1, 高橋 秀一2, 小西 孝1

Kanji IGA1, Chisato IZUMI1, Shuichi TAKAHASHI2, Takashi KONISHI1

1天理よろず相談所病院循環器内科, 2天理よろず相談所病院臨床病理部

1Department of Cardiology, Tenri Hospital, 2Department of Clinical Pathology, Tenri Hospital

キーワード : Coronary artery fistula , Transthoracic echocardiography , Transesophageal echocardiography

We analyzed seven cases of angiographically proved coronary artery fistula retrospectively to study the usefulness and limitations of transthoracic and transesophageal echocardiography. Anomalies included coronary to right ventricular fistula, three cases; coronary to left ventricle, one case; coronary to pulmonary artery, one case; and anomalous origin of the left coronary artery from the pulmonary pulmonaly artery (ALCAPA), two cases. Proximal coronary arteries were normal in size in one case of pulmonary fistula, although one aneurysm of the coronary artery and one anomalous vessel were present. Initial transthoracic echocardiography led to a diagnosis in only three cases. After minute examination, however, an abnormal channel was identified adjacent to the Valsalva sinus in five cases and was proved to be a dilated coronary artery in four of them. A color flow signal was seen in the septal branch of the left anterior descending artery in one case of ALCAPA. Transesophageal echocardiography showed dilatation of a proximal coronary artery connecting to an enlarged vessel located in the atrioventricular groove. Maximal velocity across the orifice was measured in three cases. ALCAPA was diagnosed by transesophageal echocardiography because the enlarged left coronary artery disconnected to the left coronary cusp, although the enlarged right coronary artery originated from the right coronary cusp. In two cases, the large number of collateral vessels made it difficult to visualize the orifice of the fistula in the angiograms; however, transesophageal echocardiography showed the anatomy of the orifice morphology in more detail. Screening for coronary artery fistula is difficult by transthoracic echocardiography; when used in conjunction with transesophageal echocarjdiography, however, transthoracic echocardiography provides synergistic information after an angiography-based diagnosis has been made.