冠状动脉-左心室微血管瘘的冠状动脉造影特点

Characters of coronary-left ventricular microfistula

目的:探讨冠状动脉(冠脉)-左心室微血管瘘的冠脉造影(CAG)特点。方法:冠脉-左心室微血管瘘9例患者CAG均采用延迟采集,直至冠状静脉窦显影;观察冠脉血管病变、微血管瘘部位、左心室造影剂弥散等情况,以分析患者的CAG特点。结果:9例患者中5例同时并发冠脉病变。微血管瘘起源自单支冠脉1例,双支冠脉6例,3支冠脉2例,所有患者均包含对角支瘘管。CAG时并无明确可见的瘘管,但在正常分布的冠脉末梢血管显影的同时造影剂经微血管瘘直接弥散至左心室,呈现特征性的舒张期"心腔染色",而在微血管瘘分布区域的冠脉分支存在明显的扭曲。结论:冠脉-左心室微血管瘘患者冠脉分布正常,但远端末梢血管与左心室直接交通,CAG时呈现特征性的舒张期"心腔染色"。以双支冠脉微血管瘘多见,均包含对角支瘘管,微血管瘘分布区域的冠脉分支存在明显的扭曲。

Objective： To analysis the characters of coronary angiographies（CAG） for coronary-left ventricular microfistula. Method： A review of 8 300 consecutive CAG performed in adults has yielded 9 cases, including 7 females. Images of CA（; were obtained under standard coronary model through delayed records. Result： The symptoms were suggestive of coronary pathology as chest compress or dyspnea. The coronary arteriographic diagnosis was usually easy when technical conditions were perfect. Uni-, bi- and multilateral fistulas were present in 1, 6 and 2 patients, respectively, and diagnal branch was involved in all patients. 5 of these 9 patients were combined with significant coronary lesions. Characteristic image of ＂intracavitary stain＂ caused by direct communication between micro artery and left ventricular was seen during diastole, with normal coronary branches distribution and without visible fistula, coronary branches related to the microfistula were obvious tortuous. Conclusion：The image of ＂intracavitary stain＂ seen during diastole was the character of coronary-left ventricular mierofistula, with normal coronary branches distribution. Bivessel microfistula was more often, and diagnal branch was all involved. Coronary branches related to the microfistula were obvious tortuous.