冠状动脉-左心室微血管瘘的临床特点

目的 探讨冠状动脉.左心室微血管瘘的临床表现和冠状动脉造影特点.方法 分析冠状动脉-左心室微血管瘘患者的临床症状、心电图和超声心动图表现以及冠状动脉造影特点.结果 自1998年至2008年的8300例冠状动脉造影中发现冠状动脉-左心室微血管瘘患者共9例.冠状动脉-左心室微血管瘘患者平均年龄71.5岁,其中7例(77.8%)为女性.所有患者均因类心绞痛样胸闷、气促入院.同时合并冠状动脉病变5例(55.6%),高血压病2例(22.2%),心脏瓣膜病1例(11.1%),心肌病1例(11.1%).微血管瘘起源于1支冠状动脉1例(11.1%)、2支冠状动脉6例(66.7%)、3支冠状动脉2例(22.2%).所有患者均有起源于对角支的瘘管.冠状动脉造影可见在末梢血管显影的同时,对比剂经微血管瘘直接弥散至左心室,呈现心腔染色影像.结论 冠状动脉-左心室微血管瘘以女性多见.微血管瘘起源于2支冠状动脉最常见,所有冠状动脉-左心室微血管瘘患者均存在起源于对角支的瘘管.

Clinical and angiographic characteristics of left coronaroventricular microfistula

Objective To investigate the clinical and angiographic characteristics of left coronaroventricular microfistula. Methods In his retrospective review, clinical, electrocardiogram, echocardiography and coronary angiography data were analyzed for patients with left coronaroventricular microfistula. Results Left coronarovcntricular microfistula was identified in 9 out of 8300 patients underwent coronary angiagraphies from 1998 to 2008 in our center. Seven patients were female (77.8%) and the average age was 71.5 years. All 9 patients had presenting symptoms of chest distress or dyspnea, coronary artery disease was documented in 5(55.6%), hypertension in 2 (22.2%) , valve disease in 1 (11.1%) and cardiomyopathy in 1 (11.1%) patient. Mierofistula originated from one single coronary artery was seen in 1 patient (11.1%), from two coronary arteries in 6 patients(66.7%), from three coronary arteries in 2 patients(22.2%). The diagonal artery was involved in all patients. The characteristic sign of microfistula from CAG was intracavitary staining. Conclusion Microfistula between coronary arteries and left ventricle is a rare disease, often originates from two coronary vessels and diagonal artery is involved in most cases.