老年冠状动脉瘘8例

目的 探讨老年冠状动脉瘘的特点。方法 对8例老年冠状动脉瘘病例的临床症状,体征,辅助检查的综合分析。结果 心肌缺血是老年冠状动脉瘘的主要表现,易误诊为冠心病。结论长期出现心肌缺血症状的患者,随着的年龄的增加,症状越来越明显,应考虑诊断冠状动脉瘘,冠状动脉造影是确诊冠状动脉瘘的最可靠的方法。     

An iatrogenic coronary arteriovenous fistula causing a steal phenomenon: an intracoronary Doppler study

We present the case of a 67-year-old man in whom a guidewire broke at rotablation of the right coronary artery, creating an iatrogenic aneurysmal arteriovenous fistula to the coronary sinus. Successful Doppler wire-guided fistula occlusion by percutaneous coil embolization lead to normalization of coronary blood flow and relief of the patient's symptoms. Myocardial ischemia in this patient may have been due to a steal phenomenon caused by coronary artery fistulae, as suggested by blood flow velocity data obtained before and after fistula occlusion.     

Right coronary artery hepatic vein fistula: a case report

There is a slight predominance for coronary artery fistulas that involve the right coronary artery, while multiple fistulas have also been reported. The usual site of termination is one or more of the low-pressure structures in the heart or the great vessels such as the right or left atria, right ventricle, coronary sinus, pulmonary artery, or superior vena cava. However, a coronary fistula that drains into a hepatic vein has not been reported in the literature. Therefore, this is the first case report indicating a right coronary artery fistula that drains into the middle hepatic vein.     

先天性冠状动脉瘘的外科治疗

目的总结外科手术治疗冠状动脉瘘的临床经验及治疗方法，以提高对该类疾病的治疗效果。方法对2001年2月至2011年11月收治的104例先天性冠状动脉瘘患者的临床资料进行回顾性分析，其中男性48例，女性56例，年龄5个月至71岁，平均年龄34岁。104例中有56例患者在非体外循环下行直接结扎及缝扎，其中微创小切口14例；48例合并其他先天畸形及心脏疾病者在体外循环下施行手术，直接结扎及缝扎瘘口，对合并的心脏畸形或疾病同期做相应的矫治。结果瘘口发生于右冠状动脉63例，发生于左冠状动脉41例，瘘人右心房21例，瘘人右心室40例，瘘人肺动脉30例，瘘人冠状静脉1例，瘘入上腔静脉1例。除1例因其他疾病死亡外，全组无手术死亡。随访2-10年，复查超声均无异常。结论先天性冠状动脉瘘可采用直接结扎及缝扎方法，部分病例可采用小切口治疗，手术效果安全有效。     

Coronary fistula between the left anterior descending coronary artery and the pulmonary artery: Two case reports

Coronary artery fistulae are rare congenital or acquired connections between the coronary vessels and the cardiac chambers or other vascular structures. We present two consecutive cases of coronary fistulae between the proximal left anterior descending artery (LAD) and the main pulmonary artery. Both cases where admitted with history of acute coronary syndromes and had multivessel coronary disease along with coronary pulmonary fistulae. The two cases were managed by coronary artery bypass grafting (CABG) and repair of the fistulae.     

Left-circumflex coronary artery to right atrium fistula with saccular aneurysm and its endovascular treatment

The combination of coronary artery aneurysm and coronary artery fistula is infrequent. A saccular aneurysm of a branch of the left-circumflex coronary artery associated with multiple fistulae to the right atrium was observed on a coronary angiogram performed in a 47-year-old female. Multidetector computed tomography coronary angiography detailed the anatomy of the abnormal coronary artery. An embolization with a microcoil was performed and the aneurysm sac was excluded.     

经导管弹簧圈栓堵法治疗先天性冠状动脉瘘

目的　探讨经导管弹簧圈栓堵冠状动脉瘘的安全性和有效性。方法　总结我院 1999年 5月至 2 0 0 2年 12月 6例 38～ 70岁 (平均年龄 5 0 7岁 )的先天性冠状动脉瘘进行栓堵治疗的患者 ,其中冠状动脉瘘由左冠状动脉至肺动脉 2例、右冠状动脉至肺动脉 2例、右冠状动脉至右下肺静脉及双侧冠状动脉至肺动脉各 1例。结果　 5例 (83 3% )栓堵后完全闭合 ;1例因瘘管迂曲 ,导管到位困难而放弃介入治疗。无手术死亡及并发症。 5例患者经体检和超声心动图随访 3～ 4 6个月 ,无残余瘘 ,无复发。结论　经导管弹簧圈栓堵先天性冠状动脉瘘不用开胸 ,病人易接受 ,安全、有效、方便 ,可作为治疗冠状动脉瘘的一种方法。     

经导管介入治疗冠状动脉瘘

目的：探讨经导管介入治疗冠状动脉瘘的方法及临床疗效。方法：经导管堵塞冠状动脉瘘14例，平均年龄7．1岁。结果：13例应用弹簧圈堵塞，平均瘘口大小为3．65mm，除3例失败外均获成功；1例（瘘口6．6mm）应用Amplatzer动脉导管未闭堵塞器堵塞成功。所有病例随访1个月－4年，均无残余分流及任何并发症。结论：经导管介入治疗冠状动脉瘘具有良好的临床疗效及安全性。可控弹簧圈一般用于堵塞瘘口较小的冠状动脉瘘，而瘘口较大的冠状动脉瘘可选用Amplatzer动脉导管未闭堵塞器。     

左冠状动脉回旋支右房瘘使用Amplatzer动脉导管封堵器封堵成功一例

1临床资料患者,男性,10岁,发现心脏杂音8年入院。8年前因感冒就诊发现心脏杂音（具体不详）,当时未予特殊治疗。2009年在多家医院多次行心脏彩超、冠脉双源CT提示：左冠状动脉右房瘘可能并左冠状动脉窦瘤（约1．8cm×1．8cm）,房缺可能;右心房、右心室、左心室扩大,二尖瓣、肺动脉轻度反流。院外曾有冠脉造影提示未发现冠脉异常,故到我院诊治。     

Transcatheter closure of right coronary artery fistula to the right ventricle

Coronary artery fistula (CAF) is an uncommon anomaly that is usually congenital but can be acquired. Although most patients are asymptomatic, some may present with congestive heart failure, infective endocarditis, myocardial ischemia or rupture. In the past, surgical ligation was the only option in the management of CAF, but since 1983, transcatheter closure of CAF has been increasing as an alternative to surgery. We report a 3-year-old boy, presented in Queen Alia Heart Institute, who underwent successful transcatheter closure of a large fistula communicating the distal part of the right coronary artery to the right ventricle. Our case differs from other CAFs in that the fistula was communicating the right coronary artery itself to the right ventricle.     

冠状动脉造影中冠状动脉先天性变异的分析

目的:分析冠状动脉先天性变异的冠状动脉造影表现,探讨冠状动脉造影的诊断价值。方法:2003年1月～2007年12月在武汉钢铁公司总医院行冠状动脉造影的患者900例,对其结果进行回顾性分析。结果:共检出67例冠状动脉先天性变异,检出率为7.44%。其中检出冠状动脉瘘9例,检出率为1.00%,并以冠状动脉-右心室瘘最为多见。12例为冠状动脉起源和分布异常,占1.33%,并以右冠状动脉的先天性变异为多见。检出冠状动脉心肌桥(壁冠状动脉)46例,检出率为5.11%,并以左前降支心肌桥多见。结论:冠状动脉先天性变异的临床症状和体征多不典型或缺如,冠状动脉造影是确诊各种冠状动脉先天性变异的重要手段。     

Vieussens’ ring fistula to pulmonary artery: embolization with grandmother-mother-child technique

A 53-year-old man with an asymptomatic fistula from the Vieussens ring to the pulmonary artery presented with progressive respiratory distress. Coil embolization of this type of fistula has been described by femoral access. The advanced transradial “grandmother-mother-son” technique for high active support safely allows successful embolization of this type of coronary fistulae.     

Fistula between a branch of left anterior descending coronary artery and pulmonary artery with spontaneous closure

Communication between a branch of left anterior descending coronary artery and main pulmonary artery is rare and has been previously described. However, spontaneous closure has not been described previously. We report such a case in a 41-year-old man with exertional angina and coronary artery disease.     

A case of multiple coronary microfistulas to the left ventricle and apical myocardial hypertrophy coexisting with stable angina

A coronary artery fistula consists of a communication between a coronary artery and a cardiac chamber, a great artery or the vena cava. It is the most common congenital anomaly that can affect coronary perfusion. However, coronary fistulas to one of the cardiac chambers and coexisting apical myocardial hypertophy are infrequent anomalies, and usually are found unexpectedly. Herein, we report a case in which all three major coronary arteries emptied into the left ventricle with apical hypertrophy, through multiple microfistulas.     

冠状动脉瘘28例诊断及外科治疗

目的 总结冠状动脉瘘的诊断和手术治疗效果。方法 28例不同部位的冠状动脉瘘患者采用超声心动图和选择性冠状动脉造影,明确冠状动脉瘘发生位置,全部采用外科治疗,统计其疗效。结果 单纯冠状动脉瘘20例,合并其他心内畸形8例;右冠状动脉瘘18例,左冠状动脉瘘8例,双冠状动脉瘘2例。瘘入右心室13例,瘘入右心房12例,瘘入左心室1例,瘘入肺动脉2例。心腔内双瘘口及三个瘘口各有1例,余26例为单一瘘口。所有病例行手术治疗,8例合并其他心内畸形同期矫治。全组无死亡及残余瘘,效果满意。结论 心脏直视手术治疗冠状动脉瘘效果肯定,合并其他心内畸形应同期矫治。选择性冠状动脉造影对明确冠状动脉瘘发生位置和（或）瘘人心腔的位置非常必要。     

Noninvasive diagnosis of coronary artery fistula by two-dimensional and Doppler echocardiography

Summary In a 48-year-old woman, the diagnosis of a right coronary arteriovenous fistula communicating with the coronary sinus was made noninvasively using two-dimensional, pulsed and color Doppler echocardiography.These noninvasive techniques were superior to angiography in delineating the cardiac chamber into which the fistula emptied.     

Multimodality imaging of a rare type of coronary cameral fistula

Coronary artery fistulas are defined as abnormal vascular connections between one or more coronary arteries and the cardiac chamber [coronary cameral fistula (CCF)] or a great thoracic vessel. Here, we present multimodality imaging findings of a rare case with CCF between the sinoatrial nodal artery and the left atrium.