先天性冠状动脉瘘合并扩张的外科治疗临床分析

Surgical treatment of congenital coronary artery fistula combined with coronary artery ectasia

目的通过回顾性分析冠状动脉瘘合并扩张手术治疗的临床资料,提出对这种复杂畸形的诊疗经验。方法回顾性分析2001年5月至2016年10月,共11例先天性冠状动脉瘘合并冠状动脉扩张的患者在解放军总医院心血管外科实施手术治疗的临床资料,根据不同冠脉解剖特点采取不同的手术方式,总结死亡和并发症发生率等临床特征性指标,并对患者进行随访。结果 1例患者术后心梗严重低心排死亡。体外循环时间(104.8±44.9)min,阻断时间(71.9±34.1)min,呼吸机辅助呼吸(26.0±20.5)h,术后出院时间(12.5±7.7)d。术后2例患者出现室性心律失常;心包填塞1例;心肌梗死2例。其余患者无并发症发生。9例患者经电话或再次住院随访,1例患者失访。随访患者均无症状存活。平均随访58.2(10~105)个月。无因心脏事件再次手术患者。结论对冠状动脉瘘合并扩张这种少见畸形患者,冠状动脉造影及多源螺旋CT三维重建是诊断的重要方法,一经确诊应手术治疗,术式应选择个体化方案,手术近远期疗效肯定。

Objective To retrospectively analyze the clinical data of coronary artery fistula （CAF） patients were treated with different surgical approaches according to the features of the coronary arteries. Clinical indicators, such as mortality and incidence of complications were recorded and analyzed. The patients were followed up. Results One patient died of perioperative myocardial infarction. The mean extracorporeal circulation time was 104.8 ± 44.9 min, the mean intubation duration was 26.0 ± 20.5 h, and the mean length of hospital stay was 12.5 ± 7.7 d. There were 2 cases of ventricular arrhythmia, 1 case of pericardial tamponade and 2 cases of myocardial infarction. No complication occurred in other patients. Nine patients were followed by telephone or re-hospitalization, and 1 patient was lost in the period. All the follow-up patients survived asymptomatically, for a period of 58.2 （ 10 - 105 ） months. There was no patient undergoing cardiac surgery again. Conclusion For the patients with this rare congenital cardiac abnormality, CAF combined with CAE, coronary arteriography and multi-slice spiral CT 3-dimensional reconstruction are important diagnostic methods. In the case of surgical treatment, surgical approaches should be selected for individually, and can result in satisfactory short- and long-term outcomes.