老年先天性冠状动脉瘘八例

冠状动脉瘘是一种先天性血管畸形.它是由于胚胎心肌在发育过程中的障碍,肌小梁间隙持续存在,致冠状动脉系统和心腔产生异常通道.该病的发病率低,症状、体征都不典型,辅助检查无特异性,误诊率较高.我们通过对8例老年冠状动脉瘘病例的临床分析,探讨冠状动脉瘘的临床特点,诊断方法及鉴别诊断,为进一步治疗提供依据.     

冠状动脉瘘1例

患者 ,女 ,70岁。以“间断性心前区不适 1个月 ,加重 2ｄ”为主诉于 2 0 0 1年 4月 18日入院。入院前 1个月无诱因出现心前区不适伴胸闷 ,发作持续 30ｍｉｎ左右症状消失 ,无胸痛、咳嗽、气喘 ,曾在某中医院求医 ,诊断为“冠心病心绞痛”给予速效救心丸口服 ,极化液静脉滴注无效 ,仍有心前区不适反复发作 ,每次发作持续时间 2 0～ 30ｍｉｎ ,1ｄ内发作 2～ 3次 ,发作时舌下含化速效救心丸 10粒 30ｍｉｎ左右症状消失。原发性高血压病史 30年 ,3年前患脑出血 ,体检 :体温 35 .5℃ ,脉搏 72次 /ｍｉｎ ,呼吸 16次 /ｍｉｎ ,血压 140 / 90ｍｍ…     

先天性冠状动脉瘘2例报告

本文报告2例先天性冠状动脉瘘,1例是右冠状动静脉瘘,另1例是左冠状动脉左室瘘。UCG及心血管造影是诊断本病的唯一方法,它可以观察到瘘孔大小,瘘管粗细及漏入部位,为外科手术提供确切的诊断依据。2例均在体外循环下行瘘口修补术。手术顺利,效果良好。     

冠状动脉-左室瘘1例

患者,男,9岁,因盗汗、反复咳嗽4年余入院。体检:神清,HR104次/min,律齐,心尖区可闻及响亮的舒张期杂音,心界向左下扩大,双肺呼吸音清,未及干湿音,腹软,双下肢不肿。心脏多普勒超声示:心脏增大,冠状动脉左室瘘。心电图示:窦性心律,左室高电压。行主动脉(AO)根部造影示:左冠状动脉(LCA)明显扩张,并可见造影剂从左回旋支(LCX)进入左心室(LV),形成LCX LV瘘(见图1),右冠状动脉(RCA)未见明显异常。讨论冠状动脉瘘是少见的先天性畸形,包括LCA、RCA的主支或分支直接通入心腔、冠状静脉窦、肺动脉、肺静脉、上腔静脉或支气管血管。Ser c…     

介入封堵术治疗老年冠状动脉瘘3例

<正>冠状动脉瘘(CAF)约占先天性心脏疾病的0.13%,而在总人群中的发病率大约为0.002%〔1〕。治疗方法包括药物的保守治疗,外科开胸手术治疗和新近开展的经皮导管介入治疗。1临床与资料1.1一般资料2010年10月到2012年10月我院心血管内科诊断为CAF的患者3例,男2例,女1例,年龄60~74〔平均(65.8±8.6)〕岁。均因反复胸闷、胸痛就诊,发现心脏杂音后     

冠状动脉瘘46例报告

冠状动脉瘘 (CF)为临床少见疾病。以往诊断 CF主要依赖超声心动图 ,但其敏感性较低 ,瘘口定位诊断不够准确 ,从而限制了治疗方法的正确选择。近年来 ,我们采用冠状动脉造影术 (CAG) ,检出 CF患者 4 6例 ,现报告如下。资料与方法 :本组男 2 1例 ,平均年龄 4 6± 12岁 ;女 2 5例 ,平均年龄 4 7± 9岁。临床表现为心绞痛 4 2例 ,乏力 2 1例 ,气短 14例 ,心悸 5例 ;心脏连续性杂音 15例 ;瘘口均在右心系统。合并冠心病和 /或高血压病 38例 ,瓣膜病 7例 ,心肌病1例。常规股动脉穿刺插管 ,采用 OEC公司生产的 96 0 0型数字减影 X线机行 CAG…     

先天性冠状动脉瘘1例

患者 ,女 ,37岁 ,因反复心悸、胸闷、乏力十余年 ,加剧 2个月入院。患者十余年前感冒后出现明显心悸、胸闷、乏力并伴有双下肢水肿 ,但无气喘、咳嗽、胸痛、晕厥等表现。在他院曾诊断为“风湿性心脏病” ,之后上述症状反复发作 ,尤其在劳累后更加明显。近 2个月来自觉症状明显加剧 ,但尚能胜任中度体力劳动。体检 :Ｔ 36 .8℃ ,Ｐ75次 /ｍｉｎ ,ＢＰ12 1/ 71ｍｍＨｇ (1ｍｍＨｇ =0 .133ｋＰａ) ,Ｒ 2 0次 /ｍｉｎ ,一般情况可 ,生长发育良好 ,口唇无发绀 ,两侧颈动脉搏动正常 ,颈静脉无怒张 ,两肺呼吸音清 ,未闻及干湿性音 ,心前区无膨隆…     

冠状动脉瘘介入堵闭术未成功1例报告

1病例报告 患儿男,2岁,因“发现心脏杂音9个月”于2005-05-16入院。体格检查：生命体征平稳。心率116次/分,律齐,胸骨左缘第4肋间闻及4级/6级连续性杂音,向心尖传导。X线胸片提示肺纹理增粗,心影增大,心胸比约0.57。心电图大致正常。心脏彩超示：右心室稍增大,右冠状动脉扩张,开口：11.5 mm,向前向下沿房室沟及右室表面迂曲走行,引流至右心室心尖部,瘘口：4.4 mm,诊断：冠状动脉瘘（从右冠状动脉到右心室）。行左右心导管检查及主动脉根部造影,显示右冠状动脉粗大,迂曲,瘘入右心室,瘘口约5.4 mm,即试行介入堵闭术。因右心室与瘘口成角大,多次经静脉顺行途径建立输送轨道未成功,遂经动脉逆行途径建立输送轨道。选用国产先健PDA8-10 mm堵闭器,置入右冠状动脉瘘处,张开前后伞后立即出现心电图Ⅱ、Ⅲ、aVF导联ST段下移,T波倒置,再行右冠状动脉造影,显示后降支冠状动脉瘘堵闭处有大量分支血管,提示堵闭术可能导致心肌缺血或心肌梗死,故放弃介入治疗,改于2005-05-24行冠状动脉瘘修补术。术中见心脏轻度增大,右冠状动脉显著增粗,迂曲,于接近后降支处瘘入右心室。手术过程顺利,术后恢复好。     

冠状动脉瘘

本文描述了冠状动脉瘘的发病机理、分型、流行病学、病理解剖、临床特点、辅助检查,重点介绍其诊断和治疗方法。     

左冠状动脉右房瘘1例

患儿 ,男 ,7岁 ,发现心脏杂音 1 0 d入院。体检 :发育稍差 ,两肺呼吸音清 ,心界左大 ,心律整齐 ,P2亢进 ,胸骨左缘第 2肋间闻及 级表浅的连续性杂音 ,性质较柔和。心脏 X线三位片示肺血增多 ,呈二尖瓣普大型 ,肺动脉段稍突 ,心胸比 =0 .57。心电图 :窦性心律 ,电轴显著左偏 ,极度顺钟向转位并左前半分支传导阻滞。超声心动图 :各房室不大 ,房间隔连续 ,主动脉无增宽。心底短轴切面见左冠状动脉扩张 ,内径达 8.1 mm,显示长度约 1 2 mm,沿其走向可见瘘口开口于右房。连续波多普勒示瘘口至右房侧双期连续性填充血流频谱 ,峰值流速 2 .41m/s。…     

经导管法封堵冠状动脉瘘临床分析

目的:探讨经导管法封堵中老年冠状动脉瘘的技术方法、有效性及安全性。方法:将7例先天性冠状动脉瘘患者进行了经导管封堵治疗,选择性冠状动脉造影见冠状动脉肺动脉瘘3例,冠状动脉心房瘘3例,冠状动脉右心室瘘1例。标准冠状动脉介入方法将微导管定位于瘘管的中段,经该导管输送Cook弹簧圈用于封堵直径<8mm的瘘管;巨大瘘管(直径>8mm)采用Amplatzer动脉导管封堵器(ADO)封堵。如瘘管形态不适于行弹簧圈或ADO封堵,则采用带膜支架。结果:采用Cook弹簧圈栓塞3例,ADO封堵1例,带膜支架封堵2例,另1例冠状动脉导引导丝致瘘道夹层而自行堵闭。即刻冠状动脉造影微量残余分流2例,术后心电图无特殊改变,临床症状缓解,无手术死亡及并发症。随访4个月~2年,无不适症状。结论:经导管法封堵中老年人冠状动脉瘘创伤小,安全有效,可作为合适患者的首选方法。     

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。     

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。     

Rare case of coronary to pulmonary vein fistula with coronary steal phenomenon

Coronary artery fistulas are abnormal connections between coronary artery territories and cardiac chambers or major vessels,most of them are congenital.Patients with coronary artery fistula can be asymptomatic or present with different symptoms like angina.Cardiac computed tomography(CT)is one of the best modalities for diagnosis.We present an elderly patient that presented with angina symptoms,non invasive stress test was positive for ischemic heart disease,coronary angiogram could not reveal any obstructive lesions,but an abnormal branch of the left descending coronary artery(LAD),cardiac CT showed fistula that connect left anterior descending coronary artery to left superior pulmonary vein.Our case is extremely rare as most of the reported cases were fistulas between LAD and pulmonary artery,but in our case the fistula between LAD and left superior pulmonary vein.In addition,our patients’symptoms resolved with anti-ischemic medical treatment without any surgical intervention.     

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.     

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.     

Transcatheter closure of coronary artery fistula using Guglielmi detachable coil

Background Coronary artery fistula (CAF) is a rare anomaly. Transcatheter CAF closure has been introduced using various materials, but only few data are available on the Guglielmi detachable coil (GDC). The advantage of using GDC for transcatheter CAF closure is more controllable, therefore much safer when compared to other coils. This report is about our experience in transcatheter closure of CAF using fibered GDC in our hospital. Methods & Results From 2002 to 2007, there were 10 patients with CAFs (age range: 28 to 56 year-old, 7 males) who underwent transcatheter CAF closure. There were a total of 19 CAFs which originated from right coronary (n = 5), left circumflex (n = 3), left anterior descending artery (n = 10) and left main trunk (n = 1). Median number of coil deployment for each fistula was 3 (range: 1 to 6). The pulmonary artery was the most common site of the distal communication of CAFs (n = 14), followed by right atrium (n = 3), left atrium (n = 1) and left ventricle (n = 1). Immediate coronary angiography after GDC deployment revealed no residual shunt in 12 (63.2%) CAFs, significant reduction of the flow in 5 (26.3%), while 2 (10.5%) could not be closed due to small size. Nine (90%) patients underwent a repeated angiography within 3 to 8 months. Among 12 CAFs that were occluded immediately post-deployment, there were 2 CAFs with insignificant residual flow. Among 6 CAFs with significantly decreased flow immediately post-deployment, 2 were occluded totally in the follow-up angiography. In total, 12 (70.5%) CAFs were occluded completely and 5 (29.5%) CAFs still had insignificant residual flow, which did not need any additional coil deployment. During a mean follow up of 4.3 ± 0.7 year, all patients remained symptom and complication free. Conclusions The fibered GDC is a safe and effective method for percutaneous closure of the CAFs.     

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.