先天性冠状动脉畸形11例报告

报告经冠状动脉造影或手术证实的单纯性先天性冠状动脉畸形11例,约占同期580例冠状动脉造影的1.6％。本组冠状动脉畸形病变分两大类:①冠状动脉瘘8例,含右冠状动脉右室瘘6例;②冠状动脉起源异常3例。指出冠状动脉瘘需与其他先天性心脏病鉴别,心脏B超对诊断有一定的帮助,冠状动脉造影为确定诊断的重要手段;对大的冠状动脉瘘应及时手术治疗。     

52例先天性冠状动脉瘘的外科治疗

目的　总结 5 2例先天性冠状动脉瘘的外科治疗效果。方法　全组 5 2例中 ,年龄 9个月～ 5 8岁 ,平均 (15 7± 16 4)岁。 36例为单纯的先天性冠状动脉瘘 ,16例合并有其他心脏外科疾病。5 2例中 ,右冠状动脉瘘占 71 2 % ,左冠状动脉瘘占 2 8 8%。瘘口于右室 ,右房 ,左室 ,左房及肺动脉分别为 42 3% ,30 8% ,11 5 % ,5 8%和 9 6 %。结果　手术均在体外循环下进行 ,10例切开冠状动脉闭合瘘口 ,2 6例经心腔闭合瘘口 ,16例分别闭合在冠状动脉内和在心腔内的瘘口 ;16例合并其他心脏病变同期矫治。心腔内发现二个瘘口者有 6例 ,三个瘘口者 3例 ,余 43例为单一瘘口。全组无死亡及残余漏。 37例随防 1个月～ 8年 ,平均 3 5年 ,均无症状。一例有ST T改变。结论　外科治疗先天性冠状动脉瘘是安全和有效的方法 ,合并有其他心脏外科疾病应同时矫治。准确判断瘘口的位置和确切可靠的缝合技术是防止残余漏的关键。     

冠状动脉瘘的临床分析

目的 探讨冠状动脉瘘的发生率及其临床表现.方法 回顾性分析近3年来在我院冠状动脉造影检查的患者,观察并记录冠状动脉瘘的发生率及其各项临床表现.结果 1026例患者中,共检出冠状动脉瘘患者6例(左主干-主肺动脉瘘2例,左主干-左房瘘1例,左前降支-左房瘘2例,间隔支-左房瘘1例),检出率为0.58%,均无合并其他先天性心脏病.患者年龄为36～70(60.3±12.8)岁;男性5例,女性1例.冠状动脉瘘患者均存在心脏杂音,其中4例有心电图改变,2例心脏彩超能检测到血流异常信号,3例合并冠心病.结论 冠状动脉瘘是一种少见的先天性心血管畸形,男性和女性发生率差异无统计学意义.冠状动脉造影是诊断冠状动脉畸形的金标准.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

Coronary Artery Fistula‐Associated Endocarditis: Report of Two Cases and a Review of the Literature

Coronary artery fistulae (CAF) are rare congenital anomalies and reported to have an incidence of 0.1–0.2% of all coronary angiograms. An association between fistulae and nonatherosclerotic coronary artery aneurysms is even more rare. In childhood, patients are mostly asymptomatic; however, patients older than 20 years old may present with signs of infective endocarditis, myocardial ischemia, congestive heart failure, and aneurysm rupture. CAF are typically identified by coronary angiography; however, there are some limited studies showing that transesophageal echocardiography (TEE) can also be useful in identifying CAF. Here we report two cases of endocarditis secondary to congenital coronary artery fistulae draining into either a cardiac cavity or a coronary sinus, which were detected by TEE. Vegetations were found at the site of the fistulae drainage. Management for young patients is either percutaneous or surgical intervention. For elderly patients with multiple comorbidities, conservative treatment is another option. In these two cases, treating endocarditis with proper antibiotics and supportive treatment, the patients' conditions improved significantly.     

Myocardial ischemia and congestive heart failure from a left main to coronary sinus fistula

A coronary artery fistula (CAF) is a rare congenital anomaly first reported by Krause in 1865. It is defined as a direct communication between the coronary artery and any surrounding cardiac chamber or vascular structure, which bypasses the myocardial capillary bed. The incidence of small CAFs in an adult population, undergoing cardiac catheterization at the Cleveland Clinic, was 0.13%. In the same series, the incidence of large or multiple fistulas was less than that of small fistulas and was present in 0.05% of all patients screened. The natural history of CAF in adults remains undefined, as does the best approach to managing these patients with recommendations for early closure as well as conservative management found in the medical literature. We present a patient initially diagnosed with a clinically silent CAF who presents 10 years later with symptoms and many of the classic findings of a CAF. An alternative model for the management of CAF in adults is discussed.     

Infective Endocarditis Related to a Coronary Artery Fistula with an Unusual Localization and Ectatic Coronary Arteries

Coronary artery fistulas (CAF) are a rare cardiac anomaly that can be either congenital or acquired. CAFs have clinical significance because of complications such as dyspnea on exertion, congestive heart failure, and cardiac tamponade. The literature also contains case reports of CAF presenting as bacterial endocarditis. We describe a 31‐year‐old man who presented with native valve infective endocarditis related to an unusual form of a CAF between the circumflex coronary artery and left ventricle. He also had giant coronary arteries, which were imaged with computed tomography angiography and transesophageal echocardiography. The diameter of the circumflex coronary artery and left main coronary artery was measured as 19 mm. Surgical intervention for heart valves was performed because of vegetations resistant to continued antibiotic treatment. At the same time, the CAF was treated with surgery.     

Fístula da Artéria Coronária: Associação entre Padrões de Trajetos,Características Clínicas e Cardiopatias Congênitas

Background Coronary artery fistula (CAF) is a direct connection of one or more coronary arteries to cardiac chambers or a large vessel; it may be associated with congenital heart disease.Objective To establish CAF pathway patterns from echocardiographic data and to correlate them with clinical aspects and congenital heart disease.Methods A total of 7.183 medical records of children under the age of five years with cardiac disease submitted to color Doppler echocardiography and Spearman’s Correlation test were used to associate signs and symptoms and cardiopathy to CAF with a significance level of 5%.Results Twenty six children (0.0036%) presented CAF: from the right coronary artery (RCA) to the right ventricle (RV) 26.92%, from the left coronary artery (LCA) to the RV 23.08%, from the anterior interventricular branch (AIVB) to RV 23.08%, RCA to right atrium (RA) 11.54%, LCA for pulmonary trunk (PT) 7.69% or AIVB for PT 7.69%. In 57.69% of the patients, there was a positively correlated symptomatology to CAF with p=0.445 related to dyspnea or cyanosis (53.84%); in 96.15%, congenital heart disease associated with CAF, mainly interventricular communication (IVC) or interatrial communication (IAC) in 34.62% positively correlated to CAF with p=0.295. CAF pathway was represented in three dimensions by software modeling, texturing and animation Cinema 4D R19.Conclusion CAF is an uncommon anatomical entity that presents a clinical picture compatible with dyspnea and cyanosis, and this is associated with congenital heart disease, mainly with IVC or IAC. According to echocardiographic analyzes, fistulas in RCA, LCA, or AIVB represent about one-third of the patients, with a priority pathway for right heart chambers.     

A young female with an unusual cause of dyspnea

Within the context of coronary artery anomalies, coronary fistulas are classified by termination. A coronary artery fistula (CAF) involves a sizable communication between a coronary artery and a heart chamber (coronary-cameral fistula) or a segment of the systemic or pulmonary system (coronary artery arteriovenous fistula). These are often due to deviations from normal embryological development. CAF may be present in patients at any age, but is usually suspected in early childhood and accounts for 0.08-0.4% of congenital cardiac anomalies. They may also be acquired by trauma or from invasive cardiac procedures. The majority of CAF arises from the right coronary artery (55%) and the left anterior descending coronary artery, with the circumflex rarely involved. The outcome of these connections depends upon the termination site. The pathophysiology of these lesions is identical. Coronary artery anomalies are difficult to detect clinically. Most are benign but some may produce symptoms that can be life threatening. We present a female with an unusual cause of dyspnea found to have a continuous heart murmur, cardiac catheterization showed an evidence of a long tract arising from the origin of the right coronary artery with flow directed towards the right atrium and the right atrial appendage.     

先天性冠状动脉瘘的介入治疗现状

冠状动脉瘘是一类少见的先天性心血管畸形,既往主要靠外科手术修复治疗。近年来,经导管介入封堵术已成为治疗冠状动脉瘘的一种安全、有效手段。为提高对冠状动脉瘘临床特征及介入治疗特点的认识,现仅就冠状动脉瘘的临床分型、病理生理特征及经导管介入治疗的适应证、禁忌证、注意事项及并发症防治等相关问题作一综述。     

先天性冠状动脉瘘的诊断与治疗(附34例报告)

目的:总结分析34例先天性冠状动脉瘘(CAF)的临床诊断治疗与外科手术方法。方法:回顾性分析应用超声心动图、64层螺旋CT、选择性冠状动脉造影等检查确诊的34例CAF患者的临床资料,其中24例为单纯性CAF,10例合并其他心脏外科疾病。结果:34例中5例直接行动脉瘘切线缝合术,其余29例均在体外循环直视下行瘘口修补并同时矫治合并心脏疾病。心腔内发现2瘘口1例,4瘘口1例,其他均为单一瘘口。所有患者术毕效果明显,无一例死亡,超声心动图复查均无残余瘘存在。22例随访0.5~3年无死亡及并发症发生。结论:64层螺旋CT检查可准确显示各种CAF的起源、行程、引流部位及并发异常,显示冠状动脉近段管腔的形态及一些较大冠状动脉瘘,是一种较为理想的无创性诊断CAF的影像方法。CAF明确诊断后,及时行外科手术治疗安全可靠,少数患者可行介入治疗。     

An unusual case of infective endocarditis involving a right coronary artery to superior vena cava fistula

Coronary artery fistulas (CAFs) are rare and mostly congenital anomalous connections between a coronary artery and a cardiac chamber or great vessel. Most CAFs are small, asymptomatic, and found incidentally during cardiac imaging. However, they can lead to serious complications including myocardial infarction, congestive heart failure, arrhythmias, or fistula rupture. CAFs have been associated with infective endocarditis, but to our knowledge, this complication has never been reported involving an isolated CAF to an otherwise anatomically normal great vessel. We report the first case of this complication in a 49‐year‐old man with a presumed streptococcus vegetation found within an isolated large, tortuous CAF connecting the right coronary artery to the superior vena cava. After completing antibiotic treatment, transcatheter closure of the CAF was performed. Since then, the patient has remained symptom‐free. This case demonstrates that CAF closure is feasible following CAF‐associated endocarditis, and that closure may represent a viable strategy for reducing risk of recurrent infection. © 2014 Wiley Periodicals, Inc.     

Giant congenital coronary artery fistula to left brachial vein clearly detected by multidetector computed tomography.

Coronary artery fistulas (CAF) are a rare anomaly in which there is communication between a coronary artery and a cardiac chamber or another vascular structure. A giant congenital CAF to the left brachial vein was identified clearly by multidetector computed tomography (MDCT) in an 84-year-old woman who presented with orthopnea and continuous murmur. Electrocardiogram was almost normal, but chest X-ray showed marked cardiomegaly with pulmonary congestion. Transthoracic echocardiography showed that the wall motion of the left ventricle (LV) was normal, but with an abnormal cavity behind the LV. CAF was suspected and coronary angiography revealed that the CAF originated from the right coronary artery (RCA), connected to the giant vessel. However, because the drainage site was not clearly detected, MDCT was performed and it became clear that the CAF originated from the RCA. The left circumflex artery flowed into the giant vessel, and drained to the left brachial vein.     

Percutaneous coronary artery fistula closure in adults: technical and procedural aspects.

BACKGROUND: Coronary artery fistulae (CAF) are an uncommon congenital anomaly characterized by an abnormal connection between the coronary arteries and cardiac chambers or vessels without traversing the usual capillary network. CAF are associated with a number of well-described symptomatic sequelae, which may necessitate treatment. With a tendency for symptoms to develop over time, symptomatic CAF may present for the first time in adulthood, with limited data existing on the technical aspects related to transcatheter fistula closure in adults. METHODS: We describe our experience in percutaneous closure of CAF in an exclusively adult population, with an emphasis on the various procedural features of device closure in this patient group. RESULTS: Attempted transcatheter CAF closure was performed in 14 patients between 1990 and 2006. Procedural success was achieved in 11 patients, with vessel tortuosity and lumen caliber important limitations in occlusion device delivery. Procedural complications included vessel dissection and device embolization. CONCLUSION: Transcatheter occlusion is a safe and effective method of therapy for symptomatic adults with CAF.