先天性冠状动脉瘘的诊断及外科治疗

Surgical treatment of congenital coronary artery fistula

目的 探讨先天性冠状动脉瘘的诊断及手术治疗方法 .方法 全组 2 0例术前均经心电图、X线、选择性冠状动脉造影、B超检查诊断的 2 0例中 17例在全麻体外循环下施行手术 ,3例未用体外循环 .结果 死于术后低心排综合征 1例 . 19例术后恢复顺利 ,出院时心前区杂音消失 .术后随访10 mo～ 2 5 a (16 / 19) ,心功能 I级 .结论 冠状动脉瘘的诊断并不困难 ,但确诊仍依赖于选择性冠状动脉造影或核磁共振心脏扫描 .手术难度不大 ,应注意修补瘘口确实 ,避免残余分流 ,如冠状动脉瘘远端仍有血管分支时 。

AIM To assess the diagnosis and surgical treatment of congenital coronary artery fistula. METHODS Twenty cases with congenital coronary artery fistula were operated under general anesthesia and cardiopulmonary bypass (17 cases). X ray, selective angiography and echocardiography were performed before the operation. RESULTS Postoperative courses were uneventful except one patient died for low cardiac output syndrom. There was no apicale audible murmur after the operation. 16 patients were followed up for 10 months to 25 years and showed excellent conditions (NY HA functional class Ⅰ). CONCLUSION Although echocardiography is helpful, the diagnosis of congenital coronary artery fistula mainly depends on the selective angiography and MRI.Closure of fistula outlet should be assured to avoid residual shunt and if distal branch vessels exist, the blood supply of the distal coronary artery should be protected.