先天性冠状动脉瘘的影像学诊断

目的：研究动脉造影对先天性冠状动脉瘘的价值及结合文献分析及其病理解剖。材料与方法：先天性冠状动脉瘘6例,男4例,女2例,年龄5－55岁,平均28．3岁,6例患者均行彩色多谱勒,X线片及动脉造影检查;3例行外科手术治疗。结果：动脉造影发现右冠状动脉右室瘘2例,右冠状动脉右房瘘1例,左冠状动脉右房瘘1例,左冠状动脉左房瘘和左冠状动脉冠状静脉瘘各1例,结论：先天性冠状动脉瘘临床表现无特征性,动脉造影是对该病诊断的可靠方法,彩色多谱勒及X线片为该病的辅助诊断方法。     

超声心动图对冠状动脉瘘的诊断价值

目的探讨超声心动图对冠状动脉瘘的诊断价值。方法回顾性分析12例经手术或介入治疗证实为冠状动脉瘘的超声心动图的声像图表现。结果12例冠状动脉瘘中,右冠状动脉瘘9例,包括右冠状动脉右室瘘6例,右冠状动脉右房瘘1例,右冠状动脉肺动脉瘘1例,右冠状动脉左室瘘1例。左冠状动脉瘘3例,其中左冠状动脉肺动脉瘘1例,左冠状动脉右室瘘1例,左冠状动脉左室瘘1例。超声心动图均清楚显示12例冠状动脉瘘的起源、走行和引流部位。结论超声心动图诊断冠状动脉瘘具有特异性,且简便、准确,可作为诊断冠状动脉瘘的首选影像学检查方法。     

彩色多普勒超声心动图诊断成人冠状动脉瘘临床应用价值

目的:探讨彩色多普勒超声心动图(CDE)在诊断成人冠状动脉瘘(CAF)中的方法和临床应用价值.材料与方法:对11例经冠状动脉造影证实的成人CAF进行回顾性分析,寻找CAF超声图像特征及规律性.结果:检出左冠状动脉分支右室瘘4例、肺动脉瘘2例(占55％)、右冠状动脉分支右室瘘2例、左房瘘1例、肺动脉瘘1例(占36％),左、右冠状动脉的分支聚集成动脉瘤血管丛汇入肺动脉1例(占9％),1例右室流出道疏通后粗大肌束断端小动脉出血误诊为右冠状动脉右室瘘.结论:超声心动图是冠状动脉瘘首选检查方法,在治疗方案的选择和术后疗效评价中均有重要的临床应用价值.     

超声心动图诊断冠状动脉瘘的价值

目的 评价超声心动图在冠状动脉瘘诊断中的应用价值.方法 回顾性分析18例经手术或介入治疗证实为冠状动脉瘘的超声心动图表现.结果 18例冠状动脉瘘中,右冠状动脉瘘15例,包括右冠状动脉右室瘘10例,右冠状动脉右房瘘2例,右冠状动脉肺动脉瘘2例,右冠状动脉左室瘘1例.左冠状动脉瘘3例,其中左冠状动脉肺动脉瘘1例,左冠状动脉右室瘘1例,左冠状动脉左室瘘1例.超声心动图均可清楚显示18例冠状动脉瘘的起源、走行和引流部位.结论 超声心动图诊断冠状动脉瘘具有特异性,且简便、准确,可作为诊断冠状动脉瘘的首选影像学检查方法.     

术前超声心动显像评价冠状动脉瘘的回顾性研究——对比手术病理结果

目的：1）评价术前超声心动显像诊断冠状动脉瘘的准确性。2）评价术中冠状动脉瘘异常结构的病理类型。方法：1985年2月－2001年6月在北京阜外心血管病医院外科手术证实证冠状动脉瘘的79例患者，其中41例术前经升主动脉造影或选择性冠状动脉造影及心导管检查明确诊断。术前全部患者有常规经胸超声心动显像结果，结果：79例术中所见，累及右冠状动脉58例（73．4％），累及左冠状动脉者21例（26．6％）。瘘入右心腔51例（64．5％），瘘入左心腔20例（26．4％），瘘入肺动脉8例（10．1％），多数为单个瘘口占93．6％，多个瘘口少见仅占6％，2例并发巨大冠状动脉瘤，伴其它先天性心脏畸形14例（17．7％），继发冠心病者3例（3．7％），伴有高血压病1例，合并瓣膜病1例，术前41例经升主动脉造影或选择性冠状动脉造影明确诊断（51．8％），其中仅1例法乐四联症合并左冠状动脉瘘入肺动脉，造影误诊为左冠状卢源于肺动脉，前常规经胸超声心动图显像68例与手术结果一致，11例术前超声心动图显像检查未描述冠状动脉。漏诊和误诊率13．9％，9／11例仅诊断合并畸形和并发疾病（法乐四联症3例，肺动脉瓣狭窄1例，室间隔缺损1例，冠心病3例，瓣膜病1例），2／11单纯冠状动脉瘘误诊，1例仍为主动脉窦瘤破裂，1例误诊为动脉地管未闭，结论：冠状动脉瘘的异常冠状动脉结构累及右冠状动脉多于左冠状动态，多数瘘于右心腔，其次左心腔，瘘于肺动脉较少，当有合并畸形时，术前超声漏诊较多，术前超声心动显像显像如能提供满意的冠状动脉解剖结构，患者可不必要经冠状动脉造影检查而明确诊断。     

彩色多普勒血流显像诊断先天性冠状动脉瘘

目的 探讨彩色多普勒血流显像(CDFI)诊断冠状动脉瘘的价值。方法 对13例冠状动脉瘘患者行CDFI检查，年龄8～68岁，仔细观察其起源、走行和引流部位。结果 13例冠状动脉瘘中，右冠状动脉瘘8例，包括右冠状动脉-左室瘘4例，右冠状动脉-肺动脉瘘2例，右冠状动脉-右室瘘和右冠状动脉-右房瘘各1例。左冠状动脉瘘5例，包括左冠状动脉-肺动脉瘘3例，左冠状动脉-右室瘘和左冠状动脉-右房瘘各1例。CDFI均清楚显示13例冠状动脉瘘的起源、走行和引流部位。13例均经冠状动脉造影证实，其中8例经手术证实。结论 CDFI诊断冠状动脉瘘简便、可行、准确，具有决定性的价值。     

先天性右冠状动脉右室瘘1例

先天性右冠状动脉右室瘘１例姜法伟先天性冠状动脉瘘是一种少见畸形，我院发现１例，报告如下：患者女，５岁，发现心脏杂音４年，活动后呼吸困难，易感冒。查体：心前区隆起，心界向左扩大。Ｂ超：四腔心示左室大，右冠状窦明显突向右室；彩色多普勒：主动脉右冠状窦内见...     

二维和彩色多普勒诊断冠状动脉瘘

冠状动脉瘘系指冠状动脉与心脏或大血管之间存在异常交通。本组9例均经手术证实;右冠状动脉左室瘘1例、左冠状动脉右室瘘1例、左冠状动脉肺动脉瘘1例,余均为右冠状动脉右室瘘。2DE见左房左室增大,主动脉增宽,并见受累的冠状动脉增粗(10～20mm)。M型偶见房室瓣舒张期扑动。彩色多普勒:右室瘘在右室内于收缩期和舒张期见五彩镶嵌异常血流束,左室瘘在左室内见舒张期五彩镶嵌异常血流     

少见先天性冠状动脉变异的冠状动脉造影分析

目的 分析少见的先天性冠状动脉变异的冠状动脉造影的表现,探讨冠状动脉造影的诊断价值。方法 收集1997－1999年410例冠状动脉造影中的先天性冠状动脉变异共16例,其中壁冠状动脉8例,冠状动脉瘘6例及先天性右冠状动脉缺如2例。冠状动脉造影,动态下观察,并进行必要的测量。结果 8例壁冠状动脉均表现为收缩期狭窄,1级3例,2级4例,3级1例。狭窄段长度17．2mm,其中3级1例行冠状动脉旁路移植术。6例冠状动脉瘘,5例源自左冠状动脉,1例源自双侧冠状动脉,2例引流入肺动脉干,4例引流入右心室。2例右冠状动脉缺如,经冠状动脉造影及主动脉造影证实。结论 冠状动脉造影是诊断少见先天性冠状动脉变异的重要手段,动态下观察是发现病变的关键。     

双源CT诊断先天性冠状动脉瘘

目的 观察双源CT在先天性冠状动脉瘘诊断中的应用价值. 方法 使用双源CT机对9例先天性冠状动脉瘘患者进行增强扫描,将获得的数据进行容积再现、多平面重建、最大密度投影、曲面重建,分析冠状动脉走行及心内外结构. 结果 左冠状动脉主干右心室瘘2例;左冠状动脉主干和(或)前降支主肺动脉瘘7例,其中5例合并右冠状动脉主肺动脉瘘. 结论 双源CT冠状动脉造影方便、快捷、无创,可以作为诊断先天性冠状动脉瘘的首选方法.     

Surgical repair of a coronary artery aneurysm associated with coronary artery fistula – a case report

Coronary artery aneurysm is a relatively rare disorder that is usually discovered as a secondary finding in patients undergoing coronary artery angiography. Coronary artery fistulas are relatively more frequent than rare aneurysms and are often associated with other cardiac abnormalities. The etiology of aneurysms is mostly atherosclerotic, and they are less frequently associated with other acquired or congenital diseases, such as Kawasaki disease, connective tissue diseases, septic emboli, arteritis, and iatrogenic disease. We report a 70-year-old woman with a rare combination of a coronary artery aneurysm associated with a coronary artery fistula, which drained into the pulmonary artery. The diagnosis of our patient was made by selective coronary angiography and confirmed by computed tomography angiography. The patient was treated surgically because of the symptomatic course of the disease.     

Congenital coronary artery fistulas in Turkish patients undergoing diagnostic cardiac angiography

A coronary artery fistula is a direct communication between a coronary artery and one of the cardiac chambers or vessels around the heart. The present study was undertaken to define the incidence, clinical findings and angiographic characteristics of congenital coronary artery fistula in Turkish adults who underwent diagnostic cardiac angiography. A consecutive series of 11,350 coronary angiography, performed between January 2000 and December 2001, was retrospectively examined for the presence of coronary artery fistulas. The incidence of congenital coronary artery fistulas was 0.08%. All the patients had chest pain during exertion or at rest. All the fistulas were single and most arose from the proximal left anterior descending coronary artery and drained into the pulmonary artery. All the fistulas were small. Surgical treatment was not indicated. A congenital coronary artery fistula in adults is a distinct though rare entity, variable in its incidence and commonly associated with coronary artery obstructive disease. Diagnosis is mostly incidental during routine coronary angiography.     

Fistulous communication between the right coronary artery and left atrium.

This report describes congenital coronary artery fistula of the right coronary artery draining into the left atrium in a young woman. The initial diagnosis of this rare anomaly was made noninvasively by echocardiography. Transesophageal echocardiography was vastly superior to transthoracic echocardiography in presenting the entire course of the fistula. The diagnosis was confirmed by coronary angiography. The fistula was successfully closed surgically.     

先天性冠状动脉瘘的产前超声特征分析

目的 分析先天性冠状动脉瘘的产前超声图像特征,总结其预后及转归。方法 回顾性分析我院产前超声检出的7例先天性冠状动脉瘘胎儿的检查资料,总结其产前超声表现,随访其临床结局。结果 产前超声诊断的7例先天性冠状动脉瘘胎儿中,孤立性冠状动脉瘘3例,合并其他畸形4例;4例为左冠状动脉瘘,3例为右冠状动脉瘘。二维超声表现：7例于左室流出道切面主动脉根部可见受累的冠状动脉显示不同程度的增宽扩张,内径2.5～4.4 mm;2例于四腔心切面可见左、右心不对称,左心偏小,其余5例基本对称。CDFI表现：7例胎儿主动脉根部或房室沟等区域探及管状异常湍流血流信号。临床结局：2例孤立性冠状动脉瘘出生后手术效果好;1例合并肺动脉狭窄、室间隔缺损及心包积液,孕37周胎死宫内;4例引产。结论 应用产前超声发现主动脉根部或房室沟等切面探及异常明亮的管状血流信号时,通过追踪其起源、走行及终点后需警惕冠状动脉瘘可能,对胎儿出生后早期治疗具有重要的临床价值。     

A case of coronary artery fistula with mitral stenosis

Coronary artery fistulae, being a rare form of congenital anomalies of the coronary arteries, are usually discovered by chance during coronary arteriography. However, these fistulae can cause an important coronary morbidity and mortality leading to angina, syncope, congestive heart failure, myocardial infarction and sudden death. The coincidence of mitral stenosis and congenital artery fistula is rare in the literature. In our case report, a patient with a coronary artery fistula originating from the circumflex, draining to the main pulmonary artery, discovered at cardiac catheterization and coronary angiography done with a prediagnosis of mitral stenosis is presented in the light of the literature.     

回声差异强化功能在冠心病诊断中的价值

目的探讨回声差异强化功能在冠心病诊断中的价值。方法分析冠心病患者100例，全部病例同期经过回声差异强化功能（Delta技术）和冠脉造影检查。以冠脉造影检查为标准，统计分析根据节段性室壁运动异常推测冠心病相关狭窄血管的准确性。结果图像满意率和较满意率达96％，回声差异强化功能对冠心病检出率为85％。回声差异强化功能估测冠心病缺血部位及范围和冠脉造影对比基本一致。结论回声差异强化功能能明显改善图像质量，尤其是对显像困难者的声像图改善更为突出，是检测冠心病敏感而准确的方法。     

Spontaneous coronary artery dissection causing acute coronary syndrome: an early diagnosis implies a good prognosis

Spontaneous coronary artery dissection is an unusual cause of acute coronary syndrome. We describe a series of cases that with an early diagnosis and aggressive treatment, which includes percutaneous angioplasty with stent implantation and cardiac surgery, had a good outcome. The objective was to study the demographic characteristics, clinical settings, treatments, and inhospital course of patients with spontaneous coronary artery dissection. We studied a retrospective case series in 3 coronary care units in third-level university hospitals. The spontaneous coronary artery dissection diagnosis was made by coronary angiography. Seven cases of spontaneous coronary artery dissections were recorded. They were 5 women and 2 men. The age range was 28 to 64 years. Two of them took oral contraceptives and one case occurred in the postpartum period. An acute anterior wall myocardial infarction was the most frequent clinical presentation, occurring in 4 of the 7 cases. In fact, the left anterior descending artery was involved in 6 cases. An urgent coronary angiogram was performed in all cases. Definitive treatment included percutaneous angioplasty and stent implantation in 3 cases, coronary artery bypass surgery in 2 case, and cardiac transplantation in another case. One patient was treated medically. None of the patients died in the hospital. Spontaneous coronary artery dissection remains an unusual cause of acute coronary syndrome. It should be included in the differential diagnosis of acute myocardial infarction, especially when it affects young, healthy females. An early clinical suspicion and diagnosis with urgent coronary angiography and aggressive treatment that includes percutaneous angioplasty with stent implantation and cardiac surgery could improve the prognosis of these patients.     

Potentialities of non-invasive diagnosis of coronary artery anomalies by electron-beam tomography and multislice computed tomography

AIM: To assess diagnostic value of electron-beam computed tomography and multislice computed tomography (EBT and MSCT) for diagnosis of congenital anomalies of coronary arteries (CA). MATERIAL AND METHODS: Non-invasive coronary angiography with EBT and MSCT has been performed in 1162 patients. RESULTS: Different anomalies of coronary arteries have been found in 10 (0.9%) patients. Results of EBT and MSCT agreed with those of coronary angiography performed in 8 cases with CA anomalies. Though 720 of 1162 patients had coronary stenoses, no significant atherosclerotic lesions were found in anomalous CA. CONCLUSION: EBT and MSCT enable non-invasive screening and diagnosis of coronary arteries anomalies.     

屏气法三维磁共振冠状动脉血管造影诊断先天性冠状动脉起源畸形

目的探讨屏气法三维磁共振冠状动脉造影(3D MRCA)显示畸形冠状动脉与主动脉根部、右心室流出道关系的可行性及价值.方法 5名临床拟诊患者、1例志愿者接受MRCA检查,以屏气法三维稳态进动快速成像(3D true-FISP)梯度回波序列采集图像,获得左、右冠状动脉图像,分析畸形冠状动脉近段与冠状动脉窦(Valsalva窦)、右心室流出道的位置关系.结果 6例MRCA均明确诊断先天性冠状动脉起源畸形,畸形血管近段均走行于主动脉根部与右心室流出道之间.结论屏气法3D MRCA可明确诊断先天性冠状动脉起源畸形,显示畸形冠状动脉近段的走行路经,是一种可行的影像诊断方法.