经导管介入治疗23例小儿先天性冠状动脉瘘

Effects of transcatheter closure in children with congenital coronary artery fistular

目的 探讨经导管介入法治疗小儿先天性冠状动脉瘘的经验。方法 男13例，女10例，年龄2．5～14．0岁。右冠状动脉右房瘘11例，右冠状动脉右室瘘6例，左冠状动脉右房瘘4例，左冠状动脉前降支右室瘘1例，左冠状动脉前降支肺动脉瘘1例。瘘管最窄处大小1．8～6．5mm。建立达到或通过瘘管的输送轨道，选择瘘口处或接近瘘口处的瘘管狭窄部位为封堵处。16例瘘管最窄处内径〈3mm的病例选用弹簧圈进行封堵，7例内径〉3mm的病例分别应用Amplatzer动脉导管未闭封堵器及国产对称型室间隔缺损封堵器进行封堵。结果 21例封堵成功，2例封堵不成功者外科手术成功缝扎冠状动脉瘘口。结论 经导管治疗冠状动脉瘘是一种创伤性小、疗效确切的方法。此技术首先必须系统地评价冠状动脉瘘的解剖类型及冠状动脉走向，保证欲封堵的血管的下游不能有正常血管的分支。同时必须严格掌握介入治疗适应证，对于瘘管扭曲严重，经导管封堵有困难的病例可行外科手术治疗。

Objective To observe the effects of transcatheter closure method for treating congenital coronary artery fistula （CAF） in children. Methods Twenty-three children with CAF received transcatheter closure. Under anesthesia, heart catheterization and selective coronary angiography were performed to show the CAF size and relationship with normal coronary artery. CAF with the narrowest inner diameter 〈 3 mm （n = 16） were occluded with coil device, and CAF with narrowest inner diameter 〉 3 mm （n = 7） were closed with Amplatzer duct or VSD occluder. Results Transcatheter closure was successfully performed in 21 cases and failed in 2 cases （ CAF is too tortuous in one case and right CAF outlet near the right coronary artery main stem in another case） and CAF were closed by surgery in these 2 patients. No residual shunt or other complications were observed during the 3 months to 3 years follow up. Conclusion Transcatheter closure was an effective and mini-traumatic method for CAF treatment in children.