先天性冠状动脉瘘的外科治疗

Surgical Treatment of Congenital Coronary Artery Fistula

目的总结外科手术治疗冠状动脉瘘的临床经验及治疗结果。方法回顾性分析2005年2月至2011年6月南京医科大学附属南京第一医院12例冠状动脉瘘患者的临床资料,其中男6例,女6例;年龄4～77(50.90±23.80)岁。合并冠状动脉瘤样扩张3例,合并卵圆孔未闭1例,合并冠状动脉粥样硬化性心脏病2例,其中1例同时合并重度主动脉瓣狭窄。1例在非体外循环心脏不停跳下手术,余11例在体外循环下行手术,其中3例心脏不停跳;1例同期行主动脉瓣置换术+冠状动脉旁路移植术。结果所有患者均康复出院。手术时间90～245(151.25±42.65)min,体外循环时间31～116(65.06±29.16)min,主动脉阻断时间18～97(43.00±33.41)min,术后住院时间10～15(12.50±1.45)d。全组无手术死亡。随访时间4个月～6年,所有患者无症状再发,无心肌缺血及残余瘘等并发症。结论冠状动脉瘘一旦明确诊断则均应尽早手术治疗,手术效果十分满意。

Objective To summarize clinical experience and surgical outcomes of congenital coronary arterial fistula（CAF）.Methods We retrospectively analyzed clinical records of 12 patients（6 males,6 females）,aged from 4 to 77（50.90±23.8） years,who underwent surgical repair of CAF in Nanjing First Hospital between February 2005 and June 2011.There were 3 CAF patients associated with coronary artery aneurysms,one with patent foramen ovale and 2 with coronary artery disease（CAD）.One CAD patient had concomitant severe aortic valve stenosis.One patient underwent surgical repair without cardiopulmonary bypass（CPB） and 11 patients underwent surgery under CPB,among whom 3 patients underwent surgery with beating heart.One patient underwent concomitant aortic valve replacement and coronary artery bypass grafting.Results All the patients recovered uneventfully.Operation time was 151.25±42.65 min（ranging from 90 to 245 min）,cardiopulmonary bypass time was 65.06±29.16 min（ranging from 31 to 116 min）,mean aortic cross-clamping time was 43.00±33.41 min（ranging from 18 to 97 min） and postoperative hospital stay was 12.50±1.45 d（ranging from 10 to 15 d）.There was no early or late death.All the patients were followed up from 4 months to 6 years and no patient had symptom recurrence,myocardial ischemia or residual fistula during the follow-up.Conclusion sAll CAF patients should be surgically treated once diagnosis are made with satisfactory surgical outcome.