起源于前降支的冠状动脉瘘18例临床分析

目的分析起源于前降支的冠状动脉瘘的临床、病理特点及手术效果。方法回顾性分析1998年2月～2007年12月在笔者医院手术的起源于前降支的冠状动脉瘘18例的临床表现、病理特征、手术方式及手术结果。结果 1998年2月～2007年12月共收治起源于前降支的冠状动脉瘘18例,男性10例,女性8例,年龄31.0±24.8岁(10天～71岁);单纯冠状动脉瘘10例,合并其他心脏疾病8例;冠状动脉瘘引流至主肺动脉11例,右心室5例,右心房1例,左心室1例;15例患者有1个瘘口,3例有2个瘘口,瘘口直径4.8±3.0mm(1～12mm)。手术方式包括心内修补5例,经冠状动脉切口修补3例,心表结扎或缝扎9例,经心内及冠脉切口修补1例。体外循环下手术13例,其中2例在并行循环下手术,非体外循环手术5例。ICU时间和气管插管时间的中位数分别为2天和10h,术后住院时间10.2±5.6天。1例发生残余瘘(5.6%),无围手术期死亡。结论起自前降支的冠状动脉瘘绝大多数均引流至右心系统,形成左向右分流。由于分流量多较小,较少引起心肌缺血。外科手术治疗安全、有效。

Surgical Outcome of Coronary Artery Fistula Originating from the Left Anterior Descending Artery

Objective To report the clinical features,pathology and surgical outcome of coronary artery fistula originating from the left anterior descending artery.Methods The clinical presentation,pathologic results,operative methods and surgical outcome of 18 patients were retrospectively analyzed.Results From February 1998 to December 2007,we operated on 10 males and 8 females with coronary artery fistula originating from the left anterior descending artery.Their age was 31.0±24.8 years(range from 10 days to 71 years).There were 10 cases of isolated coronary artery fistula and 8 cases with concomitant heart diseases.The fistula drained to the main pulmonary artery in 11 cases,right ventricle in 5,left ventricle and right atrium,each in 1 patient.The orifice was single in 15 cases and double in 3,with a mean diameter of 4.8±3.0mm(1-10mm).Surgical procedure was ligation in 9 cases,transarterial closure in 3,intracardiac repair in 5,and transarterial and intracardiac in 1.Cardiopulmonary bypass was used in 13 cases,with the ascending aorta clamped in 11 and the heart beating in 2.Off-pump closure was done in 5 cases.The median times of ICU stay and to extubation were 2 days and 20 hours,respectively.The length of postoperative hospital stay averaged 10.2±5.6 days.There was no operative death and residual fistula occurred in 1 case.Conclusion The majority of coronary artery fistula originating from the left anterior descending artery drains to the right heart and gives rise to left to right shunt.The shunt is usually small and rarely leads to myocardial ischemia.Surgical treatment is safe and effective.