SPONTANEOUS CLOSURE OF FISTULA BETWEEN RIGHT CORONARY ARTERY AND RIGHT VENTRICLE IN AN INFANT
Autori:
Ivan Malčić, Dražen Belina, Roland Gitter, Mladen Viljevac, Hrvoje Kniewald, Nikola Krmek
Sažetak
Sažetak. Prikazujemo spontanu okluziju fistule između desne koronarne arterije i desne klijetke kod ženskog dojenčeta, što se rijetko opisuje u literaturi. Kod bolesnice je u dobi od tjedan dana nađen kontinuirani šum 3/6 u 3. međurebrenom prostoru desno. Ultrazvukom srca je s visokim stupnjem vjerojatnosti postavljena sumnja na koronarnu arteriovensku fistulu, koja je i dokazana u dobi od mjesec dana aortografijom. Radioangioscintigrafski i oksimetrijski veličina lijevo-desnog pretoka (»shunting«) iznosila je 47%. Zbog veličine pretoka planirana je kirurška korekcija, ali je šum u međuvremenu nestao. U dobi od 6 mjeseci učinjena je kontrolna koronarografija koja pokazuje da je fistula nestala (spontano zatvaranje), ali perzistiraju druge neočekivane morfološke promjene. Sam mehanizam spontanog zatvaranja još nije poznat. Ni terapija koronarne arteriovenske fistule još nije jednoznačno određena. Koronarografija u dobi od godinu dana pokazuje regresiju i većine drugih patoloških pojava. Na osnovi literature i vlastitog iskustva smatramo da je invazivna terapija preporučljiva djeci s izraženim kliničkim simptomima. Bolesnicima bez simptoma konzervativni pristup je opravdaniji, budući da postoji mogućnost spontanog zatvaranja, čak, kao što smo pokazali, i većih fistula.
Summary
Summary. Here is presented a rare case of spontaneous closure of a fistula between the right coronary artery and the right ventricle in a female infant. At the age of 7 days continuous murmur intensity 3/6 was registered in the 3rd intercostal space along the right sternal border. Echocardiography indicated, with high probability, a coronary artery fistula. Definitive diagnosis was made at the age of 1 month with aortography. Radioscintiography and oximetric analysis revealed 47% of left-to-right shunting at level of fistula. Because of the size of the shunting a surgical correction had been planned, but in the mean-time the murmur had gone. At the age of 6 months control aortography showed spontaneous closure of the fistula, but with significant morphological changes in the right coronary artery (stenosis and aneurysms). The exact mechanism of spontaneous closure is unknown, as is the timing of therapeutic intervention. Control coronary angiography after 1 year showed the regression of pathological changes in the right coronary artery. Based on the literature and our own experiences we consider invasive therapy indicated in children with significant clinical symptoms. In cases were clinical symptoms are absent expectative state should be taken, because there is a chance of spontaneous closure of fistulas, even larger ones, as it is in our case.
