先天性冠状动脉瘘的诊断与治疗

摘要：目的对先天性冠状动脉瘘的诊断与治疗结果进行总结，以提高治疗效果。方法回顾性分析2006年7月至2013年1月上海交通大学医学院附属新华医院23例冠状动脉瘘患者的临床资料，其中男15例，女8例；年龄（35．4±8．7）岁。瘘口起始于左前降支7例，右冠状动脉13例，双侧冠状动脉1例，左主干1例，钝缘支1例；瘘入肺动脉16例，右心室5例，右心房2例。12例患者在非体外循环心脏不停跳下施行手术，11例在体外循环下施行手术。手术方法包括：心外带垫片缝扎、心内褥式缝扎、心内垫片修补瘘口、心内缝扎＋心外修补等。结果全组患者无手术死亡，无严重并发症发生。11例体外循环手术患者CPB时间（78．6±7．4）min，主动脉阻断时间（39．0±5．9）min。术后心功能恢复良好，自觉症状消失，无心肌缺血及残余瘘等并发症发生。术后门诊及电话随访12例，随访时间3个月至6年，所有患者心功能均恢复良好，复查超声心动图均无异常。无远期死亡，无心肌缺血及残余瘘等并发症发生。结论先天I生冠状动脉瘘一旦明确诊断均应尽早手术治疗。根据病变的病理特点、有无心内畸形决定手术方式。手术效果满意。

Diagnosis and Treatment of Congenital Coronary Artery Fistulas

Objective To summarize diagnosis and treatment outcomes of coronary arterial fistulas （CAFs） so as to improve surgical results. Methods Clinical data of 23 patients with CAFs who underwent surgical repair in Xinhua Hospital, School of Medicine, Shanghai Jiaotong University from July 2006 to January 2013 were retrospectively analyzed. There were 15 male and 8 female patients with their age of 35.4 ＋ 8.7 years. CAFs originated from left anterior descending artery in 7 patients, right coronary artery in 13 patients, dual coronary arteries in 1 patient, left main coronary artery in 1 patient, and obtuse marginal artery in 1 patient. CAFs drained into pulmonary artery in 16 patients, right ventricle in 5 patients, and right atrium in 2 patients. Twelve patients received surgical repair under off-pump condition with beating heart, and the other 11 patients underwent surgery under cardiopulmonary bypass （CPB）. Surgical techniques included extracardiac gasket interrupted suture ligation, intracardiac mattress suture ligation, intracardiac gasket interrupted suture for fistula repair, and a combination of intracardiac suture ligation and extracardiac repair. Results There was no in-hospital death or serious postoperative complication in this group. For the 11 patients undergoing surgical repair under CPB, average CPB time was 78.6-4-7.4 minutes, and average aortic cross-clamping time was 39.0＋ 5.9 minutes. Postoperatively, patients＇ heart function recovered well, their symptoms disappeared, and there was no myocardial ischemia or residual fistula. Twelve patients were followed up at the outpatient department and via telephone for 3 months to 6 years after discharge. During follow-up, their heart function all recovered well, and echocardiogram detected no abnormality. There was no late death, myocardial ischemia or residual fistula. Conclusion All CAFs patients need early surgical repair once their diagnosis is clear. Appropriate surgical strategies should be chosen according to the characteristics of pathological anatomy and associated intracardiac lesions. Surgical outcomes are satisfactory.