先天性冠状动脉瘘20例临床分析

Clinical analysis of 20 patients with congenital coronary artery fistula

目的 总结先天性冠状动脉瘘的临床特点及诊断、治疗方法。方法 回顾分析2001年9月至2006年7月我院收治通过选择性冠状动脉造影确诊的20例先天性冠状动脉瘘患者的临床资料。结果 冠状动脉瘘来自左冠状动脉12例（60％），包括左主干至肺动脉瘘2例和左前降支至肺动脉瘘10例；来自右冠状动脉7例（35％），包括4例至肺动脉瘘和3例至右心室瘘；1例（5％）来自双侧冠状动脉，也均瘘入肺动脉。主要表现有胸闷、胸痛的9例（45％），劳累性气促7例（35％），心悸4例（20％）。心电图表现正常8例，左心室肥大3例，右心室肥大4例，有心肌缺血表现5例。8例行介入封堵治疗，6例行外科手术治疗，其余6例未做治疗。20例患者随访1个月～5年，预后良好。结论 先天性冠状动脉瘘可经选择性冠状动脉造影确诊，手术治疗或介入治疗均安全、有效，远期效果良好。

Objective To summarize the clinical character and treatment of congenital coronary artery fistula （CAF） in 20 patients. Method Twenty adult cases of coronary fistulas from September 2001 to July 2006 were retrospectively analyzed. All patients were undergone elective coronary angiography to confirm the diagnosis. Results The rate of coronary fistula from left coronary artery was 12 cases （60%） （including 2 cases with the left main stem to pulmonary artery and 10 cases with the left anterior descending to pulmonary artery）, whereas the rate of coronary fistula from right coronary artery was 7 cases（35% ） （including 4 cases to pulmonary artery and 3 cases to right ventricle）,and 1 case（5% ） from both coronary to pulmonary artery. Six cases received surgical procedures, and 8 cases were treated with transcatheter coil embolization. The other 6 patients were not given any treatment. Twenty patients were followed-up for 1 month to 5 years. There was a good prognosis and no clinical symptoms found in all patients during follow-up. Conclusion Most patients of CAF can be definitely diagnosed by coronary angiography. The surgical and transcatheter coil embolization treatment of CAF is safe and efficient.