冠状静脉窦闭锁的诊断与临床意义

Diagnosis and Clinical Meaning of Coronary Sinus Orifice Atresia in Relevant Patients

目的：评价冠状静脉窦闭锁（CSOA）患者的诊断与临床特点。方法：回顾分析2005-02至2014-05我院诊断的22例CSOA患者,其中男性15例,女性7例,年龄1.5~76[平均（50.88±14.97）]岁。22例患者均行心电门控心脏增强计算机断层摄影术（CT）。结果：22例患者经心电门控心脏增强CT诊断为CSOA。按患者冠状静脉内血液回流方向分类：9例患者血液回流入左心房[3例伴永存左上腔静脉（LSVC）且其内血液亦入左心房,其中2例合并复杂先天性心脏畸形];5例血液回流入右心房（直接回流入右心房2例,间接经LSVC回流入右心房3例）;8例经细小分支血液既入左心房亦入右心房属混合型（4例伴LSVC）。CSOA患者9例伴LSVC。按患者LSVC内血液回流方向分：3例患者LSVC血液直接引流入左心房;6例患者LSVC血液经无名静脉-右上腔静脉-引流入右心房。超声心动图均未诊断CSOA。心电图显示5例患者有心律失常,其中3例射频消融成功,1例射频消融失败,1例行永久起搏器植入术。22例患者中6例合并先天性心内畸形（6/22,27.27%）,其中1例伴房间隔缺损,5例伴复杂先天性心脏病（先心病）。复杂先心病患者中3例术前行心电门控心脏增强CT检查发现CSOA;另2例复杂先心病患者术后仍存在症状,经CT检查发现CSOA。5例复杂先心病患者均行手术,本组无因单纯CSOA行外科手术者。结论：明确诊断CSOA患者中心律失常、LSVC和心内畸形等并发情况,对预防心血管意外的发生有重要意义。心电门控心脏增强CT对CSOA的诊断有重要价值。

Objective：To evaluate the clinical characteristics in patients with coronary sinus orifice atresia（CSOA）.Methods：We retrospectively studied 22 CSOA patients for their clinical characteristics of cardiovascular involvement.They were treated in our hospital from 2005-02 to 2014-05 including 15 male and 7 female at the age of 1.5-76（50.88 ± 14.97） years.All patients receive echocardiography and coronary CTA examination.Results：The diagnosis of CSOA was confirmed by contrast-enhanced cardiac MDCT in all patients.According to coronary vein blood flow direction,the patients were classified into 3 types：LA（left atria） type,n = 9 patients with blood flow back into LA including 3 cases from left superior vena cava（LSVC） to LA and 2 combining with complicated congenital cardiac abnormalities.RA（right atria） type,n =5 patients with blood flow back to RA including 2 cases directly to RA and 3 cases indirectly from LSVC to RA.Mixed type,n =8 patients with small branch of blood flow back to both LA and RA including 4 cases combining LSVC involvement.There were 9/22 patients with LSVC involvement including 3 with blood flow directly to LA and 6 with blood flow via in-nominate vein to RSCV then to RA.Echocardiography could not diagnose CSOA.ECG showed 5 patients with arrhythmiaand 3 of them had successful RFCA,1 failed RFCA and 1 received permanent pace maker implantation.There were 6/22 patients combining congenital cardiac abnormalities including 1 of atrial septal defect（ASD）,5 of complicated congenital heart disease（CHD）,and 3 of them with confirmed CSOA diagnosis by contrast-enhanced MDCT before operation,2 having post operative symptom and the diagnosis was confirmed by CT.All 5 CHD patients received operation and no one had operation for CSOA alone.Conclusion：Clear diagnosis of CSOA and its associated arrhythmia,LSVC involvement and cardiac abnormalities are important for preventing cardiovascular accident.Contrast-enhanced MDCT has the important value for diagnosing the patients with CSOA.