外科治疗冠状动脉解剖异常28例

Analysis of operative therapy in 28 cases of coronary artery anomalies

目的回顾分析28例冠状动脉解剖异常患者资料,探讨此症的外科治疗措施及初步体会。方法28例冠状动脉解剖异常患者,其中冠状动脉起源于肺动脉2例,冠状动脉瘘8例,左前降支心肌桥14例,冠状动脉瘤4例。体外循环下手术12例,非体外循环下手术16例。其中冠状动脉起源于肺动脉手术采用冠脉开口移位于主动脉1例,Takauchi手术1例;冠状动脉瘘体外循环下修补6例、冠状动脉下瘘口切线缝扎1例,非体外循环下左前降支-肺动脉之间瘘管结扎1例;左前降支心肌桥行MIDCAB4例,OPCAB8例,体外循环下行心肌桥松解术2例;冠状动脉瘤采用体外循环下CABG术2例,OPCAB8例,其中冠状动脉瘤成形术1例,冠状动脉瘤切除术1例。结果全组病例术后无死亡。12例体外循环手术平均体外循环时间(62.67±21.39)min,平均主动脉阻断时间(40.25±14.07)min。冠脉搭桥手术血管桥共28支,静脉桥5支,平均搭桥(1.79±1.12)支。平均住院时间(19.20±8.64)天。冠状动脉瘘病例术后心脏超声检查未见瘘口残余分流,冠脉搭桥术后病例未见心绞痛再发,心电图检查未见明确心肌缺血表现。25例无任何术后并发症,恢复良好,3例出现术后心肌缺血,心绞痛症状。结论本研究中出现术后心肌缺血症状,手术疗效有待进一步临床积累和随访。冠状动脉解剖异常外科治疗时,应争取解剖学和生理学上同时纠正冠状动脉病变,避免术后心肌缺血的发生。

Purpose To retrospectively analyze the data of operative therapy in 28 cases of coronary arteries anomalies. Methods The 28 cases of coronary artery anomalies included 2 cases of coronary artery originated from pulmonary artery, 8 cases of coronary fistula, 14 cases of myocardial bridging, and 4 cases of coronary artery aneurysm. The repair of coronary artery fistula included closure of the orifice of the fistula on Cardiac-Pulmonary Bypass（CPB）, ligation and closure with mattress suture beneath the coronary artery. Coronary artery bypass graft（CABG）, Off-pump coronary artery bypass or minimally invasive direct coronary artery bypass were utilized to correct the myocardial bridging and coronary artery aneurysm. Reimplantation of the anomalous orifice of coronary artery and Takauchi procedure were used to repair coronary artery anomalous origin from pulmonary artery. Results No post operative death occurred in these cases. The average CPB time was （62.67 ± 21.39） rain, and aorta cross clamping time was （40.25 ± 14.07） rain. The average graft of CABG was 1.79 ± 1.12. No leakage occurred in these cases after operations. Angina pectoris happened in 3 cases post-operatively. Conclusions Post-operative complication, myocardial ischemia, occurred in our study. Operative therapy should correct the anomalies both anatomically and physiologically in order to avoid the coronary ischemia.