经皮介入封堵治疗70例冠状动脉瘘疗效分析——单中心经验

目的 评估经皮介入封堵术治疗冠状动脉瘘的疗效,并总结单中心经验.方法 回顾性分析2009年8月至2015年8月在第二军医大学长海医院成功行经皮冠状动脉瘘封堵术治疗的70例患者的临床资料.结果 70例患者中男性42例(60.00％),女性28例(40.00％),平均年龄为(56.30±15.54)岁(15～83岁).共有101个瘘,其中瘘管起源于左主干9例(8.91％),前降支43例(42.57％),回旋支15例(14.85％),右冠34例(33.67％);瘘终止于肺动脉79例(78.22％),右心房16例(15.84％),右心室2例(1.98％),其他4例(3.96％).瘘管的平均直径为(3.95±2.61) mm,均封堵成功,其中使用弹簧圈封堵60例(85.71％),平均植入弹簧圈(2.55±1.76)枚;动脉导管未闭封堵器封堵5例(7.14％),plug封堵2例(2.86％),肌部室间隔缺损封堵器封堵2例(2.86％),封堵器的平均直径为(13.33±4.32) mm;带膜支架封堵1例(1.43％).术后服用阿司匹林肠溶片3～5 mg/(kg·d)6个月,随访1～73个月,平均(33.94±20.93)个月,患者均未发生出血、溶血、栓塞、胸痛及其他不良反应.结论 经皮介入封堵冠状动脉瘘是安全、有效,手术创伤小,可在临床推广应用.

Efficacy analysis of transcatheter closure of coronary artery fistulas in 70 cases: a single center experience

Objective To evaluate the efficacy of percutaneous intervention closure of coronary artery fistula(CAF) and summarize our single-center experience. Methods We retrospectively analyzed the clinical data of 70 patients who successfully underwent transcatheter closure of CAF from August 2009 to August 2015 in our department. Results There were a total of 101 fistulas in the 70 patients (female 40%, average age56.30±15.54] years, ranged from 15-83 years). And it was found that 8.91% of the CAFs were originated from the left main artery, 42.57% from the left anterior descending coronary artery, 14.85% from the left circumflex coronary artery, and 33.67% from the right coronary artery. The drainage sites included the pulmonary artery (78.22%), the right atrium(15.84%), the right ventricle(1.98%), and others (3.96%). The mean diameter of fistulas was (3.95±2.61) mm. All the 70 patients underwent transcatheter closure successfully, and the devices included coils (85.71%, mean number of coils were2.55±1.76]), patent ductus arteriosus closures (7.14%), plug (2.86%), muscular ventricular septal defect occluders (2.86%) and covered stent (1.43%).The mean size of occluders was (13.33±4.32) mm. The patients received aspirin (3-5 mg/kg) every day for 6 months postoperatively. Follow-up ranged from 1 to 73 months (average33.94±20.93]months), and no patient showed hemorrhage, hemolysis, thrombosis, chest pain or other complications. Conclusion Transcatheter closure of CAF is safe and efficient, with less trauma, and it is therefore worth popularizing in clinic.