左冠状动脉瘘的影像诊断与介入治疗

Imaging diagnosis and interventional treatment of the left coronary artery fistula

目的 :探讨左冠状动脉瘘的影像诊断和介入治疗价值。方法 :2 7例均行X线平片和彩色多普勒检查 ;行升主动脉造影者 4例 ,选择性冠状动脉造影者 2 3例 ;3例行介入治疗 ,16例于体外循环下行冠状动脉瘘修复术。结果 :5例X线平片和 15例彩色多普勒检查基本上能提示诊断 ,血管造影均能明确诊断 ,血管造影显示左冠状动脉瘘通过左前降支和左回旋支形成较粗大的瘘口者 16例 (5 9.3% ) ,左冠状动脉细小分支瘘者 11例 (40 .7% ) ,其中发生于左冠状动脉前降支的细小分支者 6例、发生于左回旋支的细小分支者 4例、同时源于左前降支和左回旋支的细小分支者 1例。在这 2 7例中 ,瘘入右心室 13例 (48.2 % ) ,瘘入肺动脉者 7例 (2 5 .9% ) ,瘘入左心室 5例 (18.3% ) ,瘘入左房者 2例 (7.4 % )。 3例患者行介入治疗 ,经 6个月随访观察 ,未见异常改变。结论 :选择性冠状动脉造影是诊断冠状动脉瘘的最佳方法 ,在治疗方面目前除手术治疗外 。

Objective:To explore the value of imaging diagnosis and interventional treatment of the left coronary artery fistula.Methods:All of the patients were examined by chest radiogram and color Doppler echocardiography,23 cases were diagnosed with selective coronary angiography,and 4 cases with ascending aortogram,3 interventional treatment and 16 surgical treatment were preformed. Results:Basicly correct diagnoses were obtained in 5 cases by plain radiography,15 cases by color Doppler echocardiography,and all cases by angiography.In the 27 cases,16(59.3%) had larger shunt via the left anterior descending or left circumflex coronary artery.There were 11(40.7%) small fistulas originating from the amall branch of the left coronary artery,6 from the left anterior descending,4 from the left circumflex coronary artery,and 1 from the left anterior descending and the left circumflex coronary artery.At the same time,there were 13(48.2%) fistulas draining into right ventricle,7(25.9%) into pulmonary artery,5(18.5%) into left ventricle,and 2(7.4%) into left atrium.Interventional treatment was successful in three patients.During the 6 month follow up,there was no cardiovascular events.Conclusion:Selective coronary angiography is of first choice for diagnosing the left coronary artery fistula.Transcatheter occlusion is a safe and effective treatment for the fistula of the left coronary artery fistula except operation.