先天性冠狀動脈瘺的臨床分析
史冬梅 周玉杰 趙迎新 張維君 崔衛東 陳長城 韋華 劉宇楊
100029 首都醫科大學附屬安貞醫院
【摘要】目的:總結61例先天性冠狀動脈瘺（CAF）的臨床特點及治療療效。方法 應用超聲心動圖、升主動脈造影及選擇性冠狀動脈造影檢查確診CAF61例，其中50例為單純性CAF，12例伴隨其他先天性畸形。起源于左冠狀動脈26例（42.5%），右冠狀動脈29例（57.5），雙側無明顯差異,但80％以上的患者引流至右心系。結果 61例冠狀動脈瘺患者中8例未進行有創干預治療；46例患者進行了外科手術治療，治愈44例，死亡2例合并其他先天性畸形；7例行導管栓堵治療，6例治愈，1例因導管到位困難停止手術。結論:超聲心動圖及選擇性冠狀動脈造影是冠狀動脈瘺主要地的確診手段，經導管栓堵術和外科手術閉合冠狀動脈瘺安全有效，建議在癥狀出現前進行根治性治療。
【關鍵詞】冠狀動脈瘺，超聲心動圖，冠狀動脈造影，外科手術，經導管栓堵
Clinical analysis 61 cases with coronary artery fistulas
Shi Dongmei Zhou Yujie Zhao Yingxin Zhang Weijun Cui Weidong Chen Changcheng WeiHua Li Yueping Liu Yuyang
AnZhen Hospital of Capital University of Medical sciences
Beijing (100029) P R China
[Abstract] Object: To summarize the clinical features, diagnostic method and therapeutic effectiveness of 61cases with congenital coronary artery fistula. Method: Investigated by echocardiogram, ascending aortography and selective coronary arteriography we diagnosed 61 cases of CAF. There are 50 patients with isolated CAF and 12 patients combined with other congenital malformation. Fistulae originate from right and left coronary arteries in almost equal proportion ---29(57.5%) and 26(42.5%)respectively, but over 80% drain to the right side of the heart. Result: there are 8 patients underwent Conservative management, while 46 patients experienced surgical closure and 7 patients experienced Tran catheter embolization. There are 2 patients who suffered with complex malformation died of operative complication and 1 patient experienced unsuccessful transcatheter treatment. Conclusion: Echocardiogram, ascending aotography and selective coronary arteriography are the major approach to diagnose the CAF. Surgical closure and transcatheter embolization are save and effective treatment. We recommended that patients should be permanent control before the symptom occurred.
[key words] coronary artery fistula echocardiography coronary arteriography
surgical closure transcatheter embolization
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