轨道辅助封堵迂曲粗大冠状动脉瘘

Occlusion of Tortuous and Giant Coronary Artery Fistula on the Wire Assistance

目的:观察伴轨道条件下释放封堵器治疗迂曲、粗大的先天性冠状动脉瘘(CAF)的可行性和安全性。方法:患者4例,非选择性主动脉或选择性冠状动脉造影后,建立动-静脉轨道,沿轨道静脉端插入长鞘至CAF最窄部位的动脉侧,保留轨道并沿长鞘推入国产动脉导管未闭封堵器,置于CAF最窄部位,重复冠状动脉造影,见残余微量血液分流或完全堵闭,观察心电图(ECG)无异常后释放封堵器。结果:4例迂曲、粗大CAF封堵成功,术中无并发症。术后分别追踪观察30个月、8个月、2个月和1周,经胸二维超声心动图(TIE)复查患者心脏大小恢复正常。血常规、血生化检查均正常,ECG:3例恢复正常。结论:对迂曲、粗大的CAF,用伴轨道释放封堵器的方法介入治疗安全、有效。用国产器械同样能获得满意效果。

Objective ： To observe the probability and safety of using occluder for treatment of tortuous and giant congenital coronary artery fistula（CAF） in the presence of wire. Methods： After non-selective or selective coronary artery angiography, a rail was constructed from femoral artery to femoral vein by using exchange wire. Through the wire from femoral vein a long sheath was inserted to the narrowest part of CAF. Then a domestic auto-dilating occluder was pushed to the narrowest part there in the presence of rail. Repeated angiography showed shunt totally disappeared or only minimal shunt left. Then the wire was pulled out. If no abnormality on electrocardiogram （ECG） was noted within 20-40 min, the occluder was delivered. Results： The operation was successful in all the 4 cases. There were no complications during the operations. These patients were followed up for 7 days-30 months. Transthoracic echocardiogram, ECG, routine blood and other biochemical examinations were all normal. The size of the heart returned to normal. Conclusion： The interventional method for treating tortuous and larger CAF is safe and effective through commodious steps. The domestic occluder can offer satisfactory effectiveness.