冠状动脉左室瘘的经皮介入封堵治疗

Percutaneous interventional occlusion of coronary artery left ventricular fistula

目的分析冠状动脉左室瘘(CALVF)经皮介入封堵治疗的方法和疗效。方法 2017年11月至2018年1月在阜外医院结构性心脏病中心就诊的4例CALVF患者,男性3例,女性1例,年龄20～37岁,平均(30.0±7.3)岁。通过体格检查、胸部X线片、超声心动图、心电图和冠状动脉CT血管造影检查明确诊断,对其CALVF进行经股动脉途径冠状动脉左室瘘封堵术。术后随访超声心动图、冠状动脉CT血管造影等6～12个月。结果 4例患者中累及右冠状动脉3例,左冠状动脉回旋支1例,远端均与左心室交通,且均可见粗大迂曲瘘管,瘘管最宽直径18～40 mm,平均(26.5±10.0)mm。瘘口直径7～19 mm,平均(12.0±5.1)mm。4例患者均建立右肱动脉和右股动脉通道,经股动脉置入动脉导管未闭封堵器对CALVF进行封堵治疗,成功率100%。随访6～12个月,无严重并发症发生。结论对于瘘管和瘘口粗大的CALVF患者,经股动脉途径冠状动脉瘘封堵术安全、有效。

Objective To evaluate the methods and efficacy of percutaneous interventional closure for coronary artery left ventricular fistula(CALVF).Methods From November 2017 to January 2018,4 CALVF patients,male 3,female 1,aged 20-37 years,average age(30.0±7.3)years were treated with percutaneous occlusion.Postoperative follow-up echocardiography,coronary CT angiography for 6 to 12 months.Results Among these 4 patients,3 cases were right coronary artery left ventricular fistula,the other one was left circumflex left ventricular fistula.All the fistulas were wide and tortuous.The diameter of the fistulas was from 18 mm to 40 mm,average(26.5±10.0)mm.The diameter of the fistula orifice was from 7 mm to 19 mm,average(12.0±5.1)mm.Before occlusion,we establish the loop from right femoral artery to right brachial artery.All the CALVF were occluded by using of patent ductus arteriosus(PDA)occluders.Technical success was achieved in all patients,the success rate was 100%.There was no residual shunt and serious complication during follow-up.Conclusions Interventional therapy via femoral artery is safe and effective for CALVF patients with large fistula and fistula orifice.