冠状动脉瘘28例诊断及外科治疗

Diagnosis and surgical treatment for 28 cases of coronary artery fistula

目的总结冠状动脉瘘的诊断和手术治疗效果。方法28例不同部位的冠状动脉瘘患者采用超声心动图和选择性冠状动脉造影,明确冠状动脉瘘发生位置,全部采用外科治疗,统计其疗效。结果单纯冠状动脉瘘20例,合并其他心内畸形8例;右冠状动脉瘘18例,左冠状动脉瘘8例,双冠状动脉瘘2例。瘘入右心室13例,瘘入右心房12例,瘘入左心室1例,瘘入肺动脉2例。心腔内双瘘口及三个瘘口各有1例,余26例为单一瘘口。所有病例行手术治疗,8例合并其他心内畸形同期矫治。全组无死亡及残余瘘,效果满意。结论心脏直视手术治疗冠状动脉瘘效果肯定,合并其他心内畸形应同期矫治。选择性冠状动脉造影对明确冠状动脉瘘发生位置和(或)瘘入心腔的位置非常必要。

Objectives To summarize diagnosis and surgical treatment effect of coronary artery fistula （CAF） Methods Twenty-eight patients with CAF were checked by echocardiogram and undergone selective coronary arteriography toconfirm their originate location, all cases received surgical procedures, and there effect of surgical treatment was summary. Results There were 20 patients without other coexisting cardiac defects, 8 patients associated with other cardiac lesions. The fistulae originated from right coronary artery in 18 patients, from left coronary artery in 8 patients, and from both （right and left） coronary artery system in 2 patients. The sites of CAF drainage were to right ventricle, right atrium, left ventricle and pulmonary artery in 13,12,1,2 patients respectively. Two and 3 distal openings of a fistula were found in each one patient, other patients all had one distal openings.All cases received surgical procedures. Eight cases associated other cardia defects were treated simultaneously.No residul shunt and clinical symptoms in all patients were found at discharge from the hospital.Conclusions Cardiac surgical procedures is a comfirmed and effective treatment for coronary fistula,other associated cardiac defects should be treated simultaneously;Selective coronary arteriography are mandatory approaches to find the proximal and distal opening of fistulas.