冠状动脉瘘封堵技巧与效果

Techniques for transcatheter closure of coronary artery fistulas

目的：冠状动脉瘘（coronary artery fistula，CAF）出口多变，形态多样，本研究探讨不同冠状动脉瘘的封堵技巧与封堵术治疗效果。方法：纳入1999年1月～2012年12月所有试图实施CAF封堵术的患者，在除外其它心脏畸形的基础上，根据主动脉或者冠状动脉造影观测CAF解剖形态，选择封堵术径路、封堵器类型和大小，封堵术后定期随访。结果：共纳入36例患者（男性17例），年龄3至74 岁（中位数21岁）。CAF起源于左冠状动脉13例（36%），右冠状动脉18例（50%），双侧冠状动脉5例（14%），引流至左心室7例（19%），右心系统29例（81%），包括右心房7例，右心室14例和肺动脉8例。成功封堵25例，成功率69%。经静脉途径封堵9例，CAF出口分别为右心房（n=5），右心室（n=3）和肺动脉（n=1）；经动脉途径封堵16例，出口分别为左心室（n=3）, 右心房（n=1）,右心室（n=10）和肺动脉（n=2）。术后出现短暂胸痛2例，心电图STT改变6例和再通1例。结论：介入方式治疗CAF安全、可靠，但具体采用何种径路和封堵器，需要根据其解剖形态确定。

AIM：To explore the results of transcatheter closure of coronary artery fistulas （CAF） with various techniques according to the anatomy of the CAF. METHODS： Patients who underwent attempted device closure of CAF between January 1999 and December 2012 were recruited into this study. After cardiac evaluation, patients underwent cardiac catheterization and angiography. The fistulas were closed using various devices and approaches according to the anatomy of the CAF. RESULTS： Thirtysix patients （17 males） aged from 3 to 74 years （median age： 21 years） underwent attempted transcatheter closure of CAF. The fistulas originated from the left coronary artery in 13 cases, right coronary artery in 18 cases, both right and left in five cases, with drainage to left ventricle in seven cases, right atrium in seven cases, right ventricle in 14 cases, and pulmonary artery in eight cases. Successful occlusion was performed in 25 cases （69%）. Transvenous device delivery was performed in nine patients with fistulas draining into the right atrium （n=5）, right ventricle （n=3） and pulmonary artery （n=1）. Transarterial device delivery was performed in 16 patients with fistulas draining into the left ventricle （n=3）, right atrium （n=1）, right ventricle （n=10） and pulmonary artery （n=2）. Procedural complications included chest pain in two cases, STT changes in six cases and fistula recanalization in one case. CONCLUSION： Transcatheter closure of coronary fistula is feasible and safe in the anatomically suitable vessels but requires different techniques for closure.