256层CT血管成像在冠状动脉瘘诊断中的价值

目的 探讨256层CT对冠状动脉瘘的诊断价值.方法 回顾分析我院2010年11月至2016年12月间收治的256层CT冠状动脉CTA检查10068例患者的影像资料,用容积再现(VR)、曲面重建(CPR)及最大密度投影(MIP)等重建方法观察有无冠状动脉瘘,分析冠状动脉瘘的CT血管造影(CTA)特点及其诊断价值.结果 10068例CTA中检出冠状动脉瘘(CAF)28例,检出率为0.28%,冠状动脉-肺动脉瘘21例,冠状动脉-右心房1例,冠状动脉-右心室1例,冠状动脉-左心室4例,冠状动脉-冠状静脉窦1例.结论 256层CT血管造影能够准确显示冠状动脉瘘的血管异常和瘘口,是诊断冠状动脉瘘的首选方法.     

冠状动脉瘘的彩色多普勒超声诊断

目的　进一步提高超声对少见病的诊断水平。　方法　对 10例冠状动脉瘘的患者行彩色多普勒超声心动图检查。　结果　冠状动脉瘘 3例 ,冠状动脉左心室瘘 3例 ,冠状动脉右心室瘘及冠状动脉左室流出道瘘各 2例。　结论　彩色多普勒超声心动图能根据冠状动脉扩张、瘘管开口位置和舒张期血流等特点 ,对本病作出准确诊断     

经胸彩色多普勒超声对先天性冠状动脉瘘的诊断价值分析

目的分析冠状动脉瘘的彩色多普勒超声心动图像特征,探讨经胸彩色多普勒超声心动图诊断冠状动脉瘘的价值。方法应用彩色多普勒超声的二维图像、多普勒频谱和彩色显像对26例冠状动脉瘘的解剖异常及心腔内异常高速血流进行观察。结果 26例患者中,超声诊断右冠状动脉瘘18例(69.2%),左冠状动脉瘘6例(23.1%),双侧冠状动脉瘘1例(3.8%)。超声心动图能清楚显示25例冠状动脉瘘的起源/走行和瘘口,超声诊断符合率为96.2%。结论彩色多普勒超声心动图对冠状动脉瘘的诊断有很高的实用价值,但对细小瘘口仍应结合冠状动脉造影检查。     

Assessment of Right Coronary Artery Fistula by Multiplane Transesophageal Echocardiography

ＡｓｓｅｓｓｍｅｎｔｏｆＲｉｇｈｔＣｏｒｏｎａｒｙＡｒｔｅｒｙＦｉｓｔｕｌａｂｙ　ＭｕｌｔｉｐｌａｎｅＴｒａｎｓｅｓｏｐｈａｇｅａｌＥｃｈｏｃａｒｄｉｏｇｒａｐｈｙＹＡＮＧＹａ（杨娅）；ＷＡＮＧＸｉｎｆａｎｇ（王新房）；ＬＩＺｈｉａｎ（李治安）（Ｄｅ...     

先天性冠状动脉瘘20例临床分析

目的 总结先天性冠状动脉瘘的临床特点及诊断、治疗方法.方法 回顾分析2001年9月至2006年7月我院收治通过选择性冠状动脉造影确诊的20例先天性冠状动脉瘘患者的临床资料.结果 冠状动脉瘘来自左冠状动脉12例(60%),包括左主干至肺动脉瘘2例和左前降支至肺动脉瘘10例;来自右冠状动脉7例(35%),包括4例至肺动脉瘘和3例至右心室瘘;1例(5%)来自双侧冠状动脉,也均瘘入肺动脉.主要表现有胸闷、胸痛的9例(45%),劳累性气促7例(35%),心悸4例(20%).心电图表现正常8例,左心室肥大3例,右心室肥大4例,有心肌缺血表现5例.8例行介入封堵治疗,6例行外科手术治疗,其余6例未做治疗 .20例患者随访1个月～5年,预后良好.结论 先天性冠状动脉瘘可经选择性冠状动脉造影确诊,手术治疗或介入治疗均安全、有效,远期效果良好.     

成人冠状动脉瘘CT冠状动脉血管成像的影像学特征及诊断

目的 分析成人冠状动脉瘘(CAF)的CT冠状动脉血管成像(CTCA)表现特征,并探讨CTCA对成人CAF的诊断价值。方法 回顾性选取行CTCA检查并确诊CAF成人患者31例。观察容积再现(VR)、曲面重建(CPR)及最大密度投影(MIP)等重建后图像信息,记录CAF的起源、瘘血管形态特征及瘘口位置,分析CAF的CTCA影像学特征及其诊断价值。结果 31例经CTCA诊断的CAF患者,起源于左冠状动脉10例(32.2%)、右冠状动脉3例(9.7%)、左右冠状动脉双侧起源18例(58.1%)。冠状动脉-肺动脉瘘25例(80.6%)、冠状动脉-左心室瘘2例(6.5%)、冠状动脉-左心房瘘1例(3.2%)、冠状动脉-右心室1例(3.2%)、冠状动脉-冠状静脉窦瘘2例(6.5%)。结论 CTCA可清晰显示CAF的起源、瘘血管形态、瘘口位置及特征性表现,是无创性诊断成人CAF的首选方法。     

双源CT对冠状动脉瘘手术前后的临床评估价值

［摘要］目的　探讨双源CT在冠状动脉瘘手术前后诊断中的应用价值．方法　回顾性分析15例CAF患者CT影像,其中11例行体外循环下的外科缝闭术．结果　15例中瘘支冠状动脉起源于右冠状动脉8例;左冠状动脉7例,其中3例窦房结支,2例前降支,2例回旋支;瘘口位于右房6例、右室5例、左室4例、左房1例;冠状动脉全程扩张8例、局限性动脉瘤形成4例、不扩张3例;单一瘘口 11例、多发瘘口4例．11例均在体外循环下手术．10例术后影像显示瘘口已缝补,未见残余瘘口; 3例显示瘘支血管近段结扎,1例右冠状动脉成形术仅见右冠近端显影,远端闭塞;2例假性憩室形成．结论　DSCT检查对冠状动脉瘘手术前后均有有重要的评估价值．     

Application of interventional diagnostic and therapeutic technique for coronary artery fine branch fistula

Objective：To explore the value of angiographic diagnosis and interventional therapy of the coronary artery fine branch fistula. Methods：All of the 18 patients with coronary artery fine branch fistula underwent selective coronary arteriography, 7 underwent interventional therapy, while 8 underwent prosthesis for coronary artery fistula （CAF） under extracorpored circulation. Results：Among 18 cases of coronary artery fine branch fistula, 7 happened in right coronary artery （38. 9%）, 11 in left coronary artery （61. 1%）. Among the 11 cases in left coronary artery,5 happened in descending anterior branch, 5 occurred in left circumflex branch, 1 arised from both left anterior branch and left circumflex branch. Among the 18 cases, there are 10 cases of coronary-to-pulmonary artery fistula （55.6%）, 5 cases of fistula draining into right atrium （27.8%）, 2 cases of fistula draining into left atrium （1 1.1% ） and 1 draining into right ventricle （5.6%）. Interventional treatment was successful in 7 patients. During the 12 months＇ follow-up, there was no cardiovascular events. Conclusion： Selective coronary angiography is the first choice for diagnosing the coronary artery fine branch fistula. In respect of therapy, besides of surgical treatment, intervention is still a rather good measure presently.     

先天性巨大冠状动脉右室瘘的介入治疗

目的 探讨经导管法封堵先天性巨大冠状动脉瘘的技术方法及其有效性与安全性.方法 对1例先天性粗大、迂曲右冠状动脉右室瘘患者进行经导管封堵治疗.选择性冠脉造影后,建立动-静脉轨道,再沿轨道钢丝经股静脉送人长鞘经瘘口至右冠状动脉,沿鞘管将动脉导管未闭封堵器置于右冠状动脉瘘口处,确定封堵器位置合适后将其完全释放.结果 瘘口完全堵闭,术后无并发症,复查心脏超声示各心腔内径缩小.结论 对迂曲、粗大的冠状动脉瘘,用国产器械经导管封堵治疗安全、有效.     

先天性冠状动脉瘘CT血管成像特征及机理研究

目的分析先天性冠状动脉瘘(CAF)CT血管成像(CCTA)特征,探讨其发病机理。方法回顾性分析47例病人CT资料,男性21例,女性26例,年龄4个月至72岁。行容积再现(VR)、最大密度投影(MIP)、多平面重组(MPR)和曲面重组(CPR)成像,同期行超声心动图成像。冠状动脉造影6例,手术治疗26例。结果右冠状动脉瘘16例,其中瘘入肺动脉6例,右心房4例,右心室5例,左心室1例。左冠状动脉瘘25例,其中瘘入肺动脉12例,右心房4例,右心室5例,左心房2例,左心室2例。左右冠状动脉同时瘘入肺动脉6例。18例呈囊状、串珠状改变,5例呈巨大瘤样扩张。24例冠状动脉无明显扩张,仅表现血管迂曲。47例中,20例超声心动图表现为血管扩张、迂曲,血流信号异常。6例造影结果以及21例手术结果与CCTA相符合。结论 MSCT清楚显示CAF的起源、行程、引流部位及并发动脉瘤以及瘤内血栓,准确诊断CAF。其形成机理包括:心肌窦状隙先天发育不良,冠状动脉与心腔持续交通以及胚胎期冠状动脉与肺动脉交通支血管退化不完全,在压力刺激及容量刺激下,导致冠状动脉与心腔或与肺动脉持续交通,逐渐形成CAF。     

Congenital coronary artery fistulas: dual-source CT findings from consecutive 6624 patients with suspected or confirmed coronary artery disease

Background  Coronary artery fistulas (CAFs) are rare congenital abnormality often unintentionally found in patients with coronary artery disease. Clinical diagnosis of CAFs is difficult due to symptomless or lack of specific symptoms. Dual-source computed tomography (DSCT) might be a useful diagnostic tool for CAFs. The study aimed to retrospectively summarize the imaging features of CAFs delineated at DSCT in 48 CAF patients detected from consecutive 6624 patients with suspected or confirmed coronary artery disease in our institution.

Methods  Forty-eight patients underwent DSCT angiography by using retrospective electrocardiographic (ECG) gating after infusion of 70 ml of intravenous contrast material during breath hold. Maximum intensity projection (MIP), curved planar reconstruction (CPR), and volume rendering technique (VR) were obtained. Anomalous termination of coronary artery in each subject was evaluated by two radiologists (with more than 10 years experience with cardiovascular imaging), and disagreement between diagnosis readers was settled by a consensus reading. Ten of 48 patients also underwent traditional coronary angiography (CAG) simultaneously.

Results  In each CAF case, DSCT angiography clearly demonstrated the origin, the termination, the size of abnormal vessel and its course in relation to surrounding great vessels. CAF arising from right coronary artery was the most common type, left circumflex was the least one involved among three coronaries, and pulmonary artery was the most common drainage site. Aneurismal fistulous tract, coronary atherosclerosis, myocardial bridging and anomalous origin of coronary artery were also detected in this group. The demonstration of drainage sites in CAG was consistent with DSCT angiography in 9 patients, and judgment on one anomalous connection in CAG was inconsistent with that in DSCT angiography.

Conclusions  DSCT angiography could provide accurate delineation of anomalous communications, size and numbers of fistulas in patients with CAFs. It suggested that DSCT is a useful tool for the assessment of CAFs and may be considered as the first-choice imaging modality, especially for patients with coronary artery disease.

     

先天性冠状动脉瘘外科治疗:22例临床分析

目的总结先天性冠状动脉瘘的临床特点,诊断、治疗方法及预后。方法回顾分析2005年6月～2009年9月我科外科手术治疗的22例先天性冠状动脉瘘患者的临床资料,手术方法及预后。结果患者成年前主要表现为心脏杂音,成年后出现不同程度的胸痛或背痛。经超声、冠脉造影或CT冠状动脉造影可以做出诊断,冠状动脉瘘源自左冠状动脉,右冠状动脉或双侧冠状动脉。开口于右心室、左心室、主肺动脉、右心房或左心房,开口数目为1处至多处,常合并其他心脏疾患。手术方式根据具体情况分别予矫治。同时对其它心脏病变进行相应处理。术后随访2个月～4a,效果良好。结论先天性冠状动脉瘘经术前检查做出诊断后,需要手术治疗,手术中应根据不同病理改变采取合适的手术方式。手术治疗安全、有效,远期效果良好。     

经胸彩色多普勒超声诊断冠状动脉瘘的临床价值

目的探讨先天性心脏病冠状动脉瘘（coronary artery fistula）的临床表现及经胸彩色多普勒超声心动图的诊断价值。方法回顾性分析32例CAF患者的临床表现及超声心动图特征。结果本组32例CAF患者超声诊断与冠状动脉造影及手术结果符合达100％。结论超声心动图对先心病CAF有较高的诊断价值，可作为首选检查方法。     

Transcatheter closure of coronary artery fistula in children

Background Transcatheter closure of coronary artery fistula （CAF） has emerged as a successful alternative to surgery. We described our experiences in 10 children patients who were accepted for transcatheter closure of CAF. Methods Ten children were 3-10 years old （seven males） with CAF who underwent percutaneous transcatheter closure between October 1995 and April 2008. Sites of origin of these fistulas were： right coronary artery in seven, left anterior descending coronary artery in two, and left circumflex coronary artery in one patient. Drainage sites of these fistulas were： right atrium in seven, right ventricle in two and left ventricle in one patient. All of these fistulas were congenital and had only one orificium fistula.Results A Cook coil was used in four patients and an Amplatzer patent ductus arteriosus （PDA） occluder was used in six patients. Checking the angiogram after the procedure revealed complete occlusion in nine patients （90%） and minimal residual flow in one （10%） patient. Technical success was achieved in all patients. Follow-up studies at short term showed complete abolition of shunt in all patients with no evidence of recanalization leading to recurrence of shunt. Conclusions Transcatheter therapy using either Cook coil or Amplatzer PDA occluder is suggested to be a safe and effective method of occlusion. The midterm outcome of the intervention for CAF is satisfactory.     

1例风湿性二尖瓣狭窄伴冠状动脉-脉动脉瘘患者的左前降支和右冠状动脉血管造影

冠状动脉瘘是一种罕见的心脏缺陷,在接受冠状动脉造影检查的成年人群中发生率约为0.2%。通常是通过主动脉造影和选择性冠状动脉造影来确诊。本文报道了1例经冠状动脉造影确诊为右冠状动脉-肺动脉瘘的风湿性二尖瓣狭窄患者,其左前降支和右圆锥支的血管情况。1例风湿性二尖瓣狭窄     

多普勒超声在冠状动脉瘘诊断中的价值

本文报告１５例先天性冠状动脉瘘,均由彩色多普勒超声心动图首先诊断。其中４例手术治疗,１例行心血管造影。冠状动脉瘘引流入右心房４例,右心室１例。右室流出道５例,主肺动脉１例,左心房２例,左心室２例。彩色多普勒超声心动图能显示冠状动脉瘘的起源、行程、远端引流部位以及冠状动脉和引流心腔内的血流性质,为诊断本病提供了一种既简便又可靠的方法。     

冠状动脉瘘的超声心动图诊断（附12例报告及文献复习）

目的通过回顾和文献复习,探讨超声心动图对冠状动脉瘘的诊断价值。方法分析12例冠状动脉瘘的超声心动图表现,其中5例升主动脉、冠状动脉造影和手术。结果冠状动脉瘘的超声瘘的超声心动图诊断与造影、手术结果相符。结论超声心动图能显示扩张的冠状动脉及走行以及瘘口血流状况,是诊断冠状动脉瘘的首选方法。     

先天性冠状动脉瘘7例超声心动图分析

目的：总结先天性冠状动脉瘘的超声心动图特征及其诊断价值。方法：利用二雏超声（2DE）、脉冲多普勒（PW）和彩色多普勒血流显像（CDFI）检测冠状动脉以发现其开口、口径及瘘口位置。结果：本组7例患者，检出右冠状动脉瘘5例、左冠状动脉瘘2例，尚未发现左右冠状动脉瘘者。结论：超声心动图对先天性冠状动脉瘘具有较高诊断价值，可作为首选的检查方法。     

Bilateral coronary–pulmonary artery fistulae associated with severe aortic insufficiency: an interesting association causing myocardial ischemia

Background  Coronary artery fistula (CAF) is defined as a direct communication of a coronary artery with a cardiac chamber, great vessel or other vascular structure, bypassing the myocardial capillary bed. Congenital CAFs joining into the pulmonary artery are rare cardiac anomalies. CAFs arising from two coronary arteries are even more rare especially when combined with valvular heart disease. The coincidence of CAFs with aortic insufficiency is relatively rare and sometimes might cause myocardial ischemia. Results  We present a case of bilateral coronary–pulmonary artery fistula combined with severe aortic insufficiency causing myocardial ischemia and who subsequently underwent fistula ligation during aortic valve surgery.     

先天性冠状动脉瘘的诊断——附3例报告

本文报告3例先天性冠状动脉瘘,1例经心血管造影证实,2例在手术中明确诊断并作了修复手术。起源于左冠状动脉者2例,其中1例与左室沟通,另1例与右室沟通。起源于右冠状动脉并与右室沟通的1例。结合文献对本病的诊断进行了较详细地讨论。