经导管法堵塞治疗先天性冠状动脉瘘

Transcatheterclosureofcongenitalcoronaryarteryfistulas

为探讨先天性冠状动脉瘘非开胸手术疗法，采用经导管法对４例冠状动脉瘘进行堵塞治疗的研究。患儿年龄分别为２．３、６．５、１１及１１岁。３例为右冠状动脉回流入右室腔，１例为左冠状动脉瘘回流入右室。４例均用弹簧圈进行堵塞，其中３例由于采用大于冠状动脉瘘直径３０％的弹簧圈，而获完全堵塞；而另１例由于应用的弹簧圈过小而未能堵塞冠状动脉瘘，弹簧圈漂至左肺小动脉，经手术取出。提示经导管置入弹簧圈堵塞先天性冠状动脉瘘的方法既安全、有效，又方便、经济，可作为替代外科开胸手术治疗冠状动脉瘘的一种方法。

Fourpatients(aged2.3,6.5,11and11years,respectively)withcoronaryarteryfistulaundergoingpercutaneoustranscatheterclosurewerestudiedtoconfirmtheeficacyandsafetyofthetherapy.Therewerethreefistulaefromtherightcoronaryarterytotherightventricle,andonefromtheleftdescendingcoronaryarterytotherightventricle.ThefistulawasoccludedwithGi-anturcocoil(COOK,Inc).Successfulocclusionwasachievedinthreepatientsusingthecoilwiththediameterof30%largerthanthatofthevesselmeasured.Theclosurefailedinonecaseandsurgicalinterventionwasrequiredfortheclosureofcoronaryarteryfistulaandtheremovalofthecoilmigrat-ingtothesmalbranchoftheleftpulmonaryarteryduetotheuseoftoosmalcoil.Onthebasisofourresult,webelievethattranscatheterclosureofcoronaryarteryfistulaswiththecoilisasafe,ef-fective,convenientandeconomicprocedurewithoutopenheartsurgery.