经皮介入封堵冠状动脉-肺动脉瘘治疗分析

Percutaneous Closure of Congenital Coronary Artery-to-Pulmonary Artery Fistula

目的:分析冠状动脉-肺动脉瘘(coronary artery-to-pulmonary artery fistula,CPAF)行经皮介入封堵治疗的可行性、安全性及疗效。方法:回顾性分析长海医院心内科于2009年7月至2016年2月之间接受经皮介入封堵术的58例CPAF患者的临床资料,排除合并其他复杂心脏病变而需要外科手术治疗的患者。结果:58名CPAF患者经介入封堵均获成功,平均植入封堵材料(2.35±0.87)枚。24名(41.38%)患者成功封堵后残余分流立即消失,34名(58.62%)患者仍有少量分流。未出现手术相关并发症。术后随访2~61个月,无出血、缺血等并发症。随访造影显示,其中3名(5.17%)患者出现了大量再通,后者随后均接受了再次封堵术并成功封堵。结论:经皮介入封堵CPAF切实可行,但应选择适宜患者,且需要经验丰富的术者操作。经治疗后冠状动脉瘘可能出现再通,因此对这些患者应进行随访造影或其他影像学检查。

Objective： This study sought to assess feasibility, safety and effectiveness of percutaneous closure of coronary artery-to-pulmonary artery fistula （CPAF）. Methods： Among the cases of CPAF confirmed by coronary angiography during July 2009 to February 2016 at our hospital, inverventional treatment was performed in 58 patients. Patients with other complex cardiac lesions and those requiring surgery were excluded. Results： Fifty-eight patients with CPAF underwent 61 percutaneous closure procedures. Successful closure occurred immediately in all patients with no residual flow in 41.38% and with trivial flow in 58.62%. A follow-up angiogram was obtained with following-up angiography of 2 to 61 months. Three patients （5.17%） of the 58 patients with follow-up angiography had large recanalization. A repeat closure procedure was performed in all 3 patients of the latter successfully. Conclusions： Percutaneous closure of CPAF is feasible and should be considered in carefully selected patients and performed by experienced operators. Recanalization of the treated coronary fistulae may occur, so follow-up angiography or other imaging modality should be performed in these patients.