先天性冠状动脉瘘的临床解剖及外科治疗

Clinical anatomy and surgical treatment of congenital coronary artery fistulas

目的:总结先天性冠状动脉瘘(CAF)的临床解剖特征及外科治疗效果。方法:本组26例,男16例,女10例,年龄7个月～58岁,平均(17.6±13.2)岁。右冠状动脉心腔瘘65.4%(17例),其中瘘口位于右心室6例,左心室2例,右心房5例,左心房4例;左冠状动脉心腔瘘26.9%(7例),其中瘘口位于右心室5例,左心室2例;左冠状动脉肺动脉瘘7.7%(2例)。单个瘘口23例,多个3例。根据其临床解剖特征,CAF在体外循环下闭合18例,非体外循环下直接结扎或缝扎8例,合并畸形同期处理。结果:本组患者无死亡。23例随访1个月～8年,平均2.8年,均无心肌梗死及残余瘘。22例心功能恢复至Ⅰ级,1例Ⅱ级。结论:外科治疗先天性冠状动脉瘘是安全和有效的方法,根据CAF的临床解剖特征,选用合适的手术方式是成功手术的关键。

Objective： To summarize clinical anatomic features and surgical treatment results of congenital coronary artery fistulas （CAF）. Methods： Twenty-six patients （16 men, 10 women）, aged from 7 month to 58 years with a average of 17.6±13.2 years were operated. The fistula originated from the right and left coronary artery to the ventricle in 17 （65.4%） and 7 （26.9%） patients, respectively. The fistula originated from the left coronary artery to the pulmonary artery in 2 （7.7%） patients. The fistula drained into the right ventricle, right atrium, left atrium, left ventricle and pulmonary artery in 11 （42.3%）, 5 （19.2%）, 4 （15.4%）, 4（15.4%） and 2 （7.7%） patients, respectively. According to the CAF clinical anatomy, the distal fistulas were closed in 18 patients with cardiopulmonary bypass （CPB） and 8 patients without CPB. The coexisting defects were corrected simultaneously. Results： Twenty-two patients were followed up for an average period of 2.8 years （1 month to 8 years）. There was no death, myocardial infarction or recurrent fistula happened. Heart function was improved to NYHA functional class Ⅰ in 22 patients and class Ⅱ in 1 patient. Conclusions： Surgical treatment is a safe and effective method for congenital coronary fistula. According to the CAF clinical anatomy, it is the key point of good surgical results to choose the appropriate surgical treatment.