经冠状动脉侧介入治疗先天性冠状动脉瘘的安全性及效果分析

Trans-catheter closure of coronary artery fistula in retrograde approach

目的：评价应用不同封堵器经冠状动脉侧治疗先天性冠状动脉瘘（CAF）安全性及效果。方法：2012年至2015年间,连续12例患者（年龄18~62岁,男性7例,女性5例）在本中心确诊为冠状动脉瘘并试行经导管介入封堵术,封堵前完成血液动力学评估及冠状动脉造影,依造影结果选择封堵器。结果：12例患者共存在13处瘘口,1例为双支病变。9例成功完成介入封堵术,1例因新瘘再形成行二次介入,故累计完成10例封堵术。使用ADO II封堵器4例,纤维弹簧圈3例,电离弹簧圈2例,血管塞联合弹簧圈1例。术后造影2例存在少量残余分流,其中1例随访中新瘘再生。无冠状动脉损伤或冠状动脉内血栓形成等并发症发生。中位随访时间15.2个月。结论：经冠状动脉侧置入封堵冠状动脉瘘安全有效,术式更为简便易行。

Objective： This study sought to evaluate the safety and efficacy of trans-catheter closure of coronary artery fistula（ CAF） in the retrograde approach with different occlusion devices. Methods： From2012-2015,12 patients（ age range from 18-62 years,seven males） were diagnosed CAF in our center. All of them were underwent trans-catheter closure. Before the procedure,hemodynamic evaluation and coronary artery angiography had been carried out. Occlusion devices were chosen based on the size and site of fistulae in angiographies. Results： Trans-catheter CAF closures were performed successfully in 10 procedures（ 9 patients）.Of them,Amplatzer Duct Occluder IIs were implanted in 4 procedures,control-release coils were used in 3 procedures（ 2 patients）,coils in 2,Vascular Plug combined coils in 1 procedure. Complete occlusions were achieved in 8 procedures. All of the devices were released from coronary artery approach. Residual shunts were detected in 2 procedures in immediate angiography. There was no procedure-related complication. Follow-up was obtained in all the patients with a median time of 15. 2 months. Eight patients had no recanalization,one of the patients with residual shunts had a significant recanalization. A second closure was carried out and the fistula was occluded completely. Conclusion： Trans-catheter CAF closure with various occlusion devices in the retrograde approach is safe and feasible. Procedure should be considered in patients with suitable anatomy,to avoid missing the opportunity of trans-catheter closure and the potential complications.