先天性冠狀動(dòng)脈瘺的臨床分析
史冬梅 周玉杰 趙迎新 張維君 崔衛(wèi)東 陳長(zhǎng)城 韋華 劉宇楊
100029 首都醫(yī)科大學(xué)附屬安貞醫(yī)院
【摘要】目的:總結(jié)61例先天性冠狀動(dòng)脈瘺（CAF）的臨床特點(diǎn)及治療療效。方法 應(yīng)用超聲心動(dòng)圖、升主動(dòng)脈造影及選擇性冠狀動(dòng)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(dòng)脈26例（42.5%），右冠狀動(dòng)脈29例（57.5），雙側(cè)無(wú)明顯差異,但80％以上的患者引流至右心系。結(jié)果 61例冠狀動(dòng)脈瘺患者中8例未進(jìn)行有創(chuàng)干預(yù)治療；46例患者進(jìn)行了外科手術(shù)治療，治愈44例，死亡2例合并其他先天性畸形；7例行導(dǎo)管栓堵治療，6例治愈，1例因?qū)Ч艿轿焕щy停止手術(shù)。結(jié)論:超聲心動(dòng)圖及選擇性冠狀動(dòng)脈造影是冠狀動(dòng)脈瘺主要地的確診手段，經(jīng)導(dǎo)管栓堵術(shù)和外科手術(shù)閉合冠狀動(dòng)脈瘺安全有效，建議在癥狀出現(xiàn)前進(jìn)行根治性治療。
【關(guān)鍵詞】冠狀動(dòng)脈瘺，超聲心動(dòng)圖，冠狀動(dòng)脈造影，外科手術(shù)，經(jīng)導(dǎo)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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