先天性冠状动脉瘘的临床分析

Clinical analysis of 61 cases of coronary artery fistulas

目的 探讨 6 1例先天性冠状动脉瘘 (CAF)的临床特点及治疗方法。方法 1984年至 2 0 0 2年 ,应用超声心动图、升主动脉及选择性冠状动脉造影检查确诊CAF 6 1例 ,其中男 34例 ,女 2 7例 ;年龄 5个月至 71岁。其中 5 1例为单纯性CAF ,10例伴其他先天性畸形。单支娈管起源于左冠状动脉 2 6例 ,右冠状动脉 2 9例。结果 8例未进行有创干预治疗。 4 6例行外科手术治疗 ,治愈 4 4例 ;死亡 2例 ,均为合并其他先天性畸形者。 7例行导管栓堵治疗 ,6例治愈 ,1例因导管到位困难停止手术。结论 超声心动图及选择性冠状动脉造影是冠状动脉瘘主要确诊手段 ,外科手术和经导管栓堵术闭合冠状动脉瘘均安全有效 ,应在临床症状出现前进行根治性治疗。

Objective: To summarize the clinical features, diagnostic method and surgical experience of 61 cases of congenital coronary artery fistula (CAF). Methods: CAF was diagnosed in 61 patients by echocardiogram, ascending aortography and selective coronary arteriography. There were 50 isolated CAF and 12 combined with other congenital cardiac malformation. The fistulae originated from right and left coronary arteries in almost equal proportion: 29 (57.5%) and 26 (42.5%), respectively. Results: 8 patients received conservative management, while 46 patients underwent surgical repair and 7 patients received transcatheter embolization. 2 patients with complex cardiac malformation died postoperatively. In 1 patient, transcatheter treatment was unsuccessful. Conclusion: Echocardiogram and selective coronary arteriography are mandatory approaches to diagnosis. Surgical closure and transcatheter embolization are safe and effective. Surgical repair should be performed before symptoms developed.