先天性冠状动脉瘘的外科治疗

SURGICAL TREATMENT OF CONGENITAL CORONARY ARTERIOVENOUS FISTULA

本文报告8例先天性冠状动脉瘘的手术治疗,5例症状完全消失,2例症状明显减轻,1例失访。对冠状动脉瘘的诊断、病理解剖、手术指征及方法进行了讨论。

Eight patients with congenital coronary A-V fistula were operated during 1957-1979.Four of these cases were diagnosed as patent ductus arteriosus preoperatively.One case had concurrent pulmonary stenosis and 2 had patent ductus arteriosus;these anomalies were also corrected surgically.The fistulas were found originated from right coronary artery in 5 and left coronary artery in 3,terminating into the main pulmonary artery in 7 and right atr(?)um in 1.During operation,fistula occlusion test was performed in 5 cases prior to obliteration of the fistulas.The operations included fistula ligation in 2,multiple suture ligation in 4 and ligation of coronary branch proximal and distal to fistula in 2.All patients survived operation.Follow-up in 7 patients(1-12 years,average 5 years)showed that symptoms were resolved in 5 and ameliorated in 2.The authors hold that preoperative aortography and selective coronary angiography are valuable diagnostic aids and surgical operation is indicated once the diagnosis is established.The risk of opera-tion is low and long-term results are gratifying.