儿童先天性冠状动脉瘘介入治疗2例报告

先天性冠状动脉瘘(coronary artery fistulas,CAF)属少见先天性心血管畸形,在先天性心血管畸形的发病构成中的占0.2%～0.4%,是先天性心血管畸形最常见的类型,具有潜在危险性.     

小儿先天性冠状动脉瘘的诊断和外科治疗

先天性冠状动脉瘘（CAF）临床上非常少见，患病率占先天性心脏病的0.27%-0.4%，病变进展缓慢，不少患儿到成年体检或出现明显症状时才发现，易延误诊治。手术是治疗该心脏畸形的有效方法，我院1970年1月-2003年12月共收治本病患儿30例，占同期先心病住院总人数的0.17%，其中21例小儿冠状动脉瘘外科手术治疗，效果良好，现报告如下。     

儿童先天性冠状动脉瘘的诊断与治疗

目的探讨儿童先天性冠状动脉瘘(CAF)的临床特征、诊断与治疗。方法回顾性分析2009年12月-2011年12月在首都医科大学附属北京安贞医院诊断为CAF患儿的临床表现、影像学检查、诊断、治疗及随访情况。结果 CAF患者12例。其中男5例,女7例;就诊年龄4个月～12岁。初诊原因心脏杂音8例、心力衰竭4例。12例患者经胸超声心动图检查示左冠状动脉右心室瘘、左冠状动脉右心房瘘、右冠状动脉右心室瘘各3例,右冠状动脉左心室瘘、右冠状动脉右心房瘘、右冠状动脉肺动脉瘘各1例。6例并其他心脏畸形,包括室间隔缺损3例、房间隔缺损2例、动脉导管未闭1例。其中8例经64排CT、2例经冠状动脉造影、2例术中经食管超声心动图检查进一步明确诊断。1例介入治疗,11例外科手术治疗。其中直接缝扎瘘口10例,心包补片1例,并心内畸形者同时矫治。12例患者术后经3～27个月门诊规律随访,心力衰竭症状缓解,心脏杂音消失,心脏大小在术后3～6个月恢复正常,仅1例存在少量残余分流。结论儿童CAF临床表现不一,多以心脏杂音、心力衰竭就诊,无创性经胸超声心动图联合64排CT可明确诊断,外科手术或介入治疗安全、有效。     

先天性冠状动脉瘘11例报告

本文报告11例先天性冠状动脉瘘,其中右冠状动脉瘘8例,左冠状动脉瘘3例,全部瘘入肺循环。瘘入右房54.5%,瘘入右室45.5%。重点介绍本病体征为连续性、浅表性杂音,部位与瘘入部位相当。X线特征为心影增大的程度明显于肺充血的程度,并在心影边缘可见局限性膨隆。心血管遗影为必要的诊断手段,可观察到瘘孔大小,瘘管粗细,瘘入部位,为外科手术提供确切的诊断依据。由于手术安全,效果良好,主张早期手术。     

先天性冠状动脉瘘的诊断与治疗：附22例报告

本文报告22例冠状动脉瘘,男14例,女8例,年龄2～12岁(平均5岁),全部病例经临床、超声心动图检查,最后经心导管及心血管造影证实。16例为右冠状动脉瘘,其中12例入右室,4例入右房;5例左冠状动脉瘘,其中4例入右室,1例入右房;1例左右冠状动脉右室瘘。18例开胸外科结扎瘘口,4例经导管法应用弹簧圈堵塞冠状动脉瘘,3例获成功。该症由于随着年龄增长引起一系列并发症,作者认为早期进行外科手术或经导管堵塞术是必须的。     

儿童先天性冠状动脉瘘71例临床分析

目的:探讨儿童先天性冠状动脉瘘(CAF)的临床特点、治疗效果及预后。方法:回顾性收集上海交通大学医学院附属上海儿童医学中心心脏内、外科2013年1月至2019年6月收治的71例先天性CAF患儿的临床资料,中位年龄2.2岁(0.1~14.0岁);中位体质量18.3 kg(3.2~55.8 kg);其中男37例(52.1%...     

超声心动图诊断先天性冠状动脉瘘

超声心动图诊断左、右冠状动脉痿4例,均经选择性冠状动脉造影和手术证实。其二维超声心动图特征是于胸骨旁主动脉根部短轴查见显著扩张的左、右冠状动脉,内径为7.8±0.15mm,与正常儿童有显著差异(P<0.01)。肋下五腔心查见扩张的左冠状动脉,目前尚未见文献报告。此外,我们采用同样方法观察正常儿童30例,其左、右冠状动脉内径均<3mm。本文结果提示:当儿童冠状动脉内径>3mm,并结合临床体征,应考虑有冠状动脉扩张。     

经导管介入法治疗小儿先天性冠状动脉瘘9例

目的探讨经导管介入法治疗小儿先天性冠状动脉瘘的方法及效果。方法广东省人民医院2002年1月至2005年1月收治的先天性冠状动脉瘘患儿9例,先行心导管检查及选择性冠状动脉造影,显示瘘管的形态及引流情况,建立达到或通过瘘管欲堵闭处的输送轨道。6例瘘管最窄处内径≤3mm的病例选用可控弹簧圈进行堵闭,3例内径>3mm的病例应用Amplazter动脉导管堵闭器进行堵闭。结果8例堵闭成功,1例瘘管扭曲严重的病例堵闭失败而行外科手术。全部病例随诊2个月至3年,随诊中无并发症发生。结论经导管介入治疗冠状动脉瘘是一种创伤性小、疗效确切的方法,但必须严格掌握介入治疗适应证。     

18例小儿先天性冠状动脉瘘的外科治疗

目的：探讨小儿先天性冠状动脉瘘的外科治疗。方法：１８例先天性冠装动脉瘘患儿中，右冠状动脉瘘１３例（７２．２％），最常见的瘘入心脏为右心室（５５．６％）。除１例施行冠状动脉瘘支直接结扎手术，均在体外循环下施行手术矫治。结果：全组无手术死亡和严重术后并发症。结论：冠状动脉瘘在诊断明确后，应及时手术治疗；体外循环下直视修复术是安全、可靠的治疗方法。     

先天性右冠状动脉右心房瘘1例

先天性右冠状动脉右心房瘘１例陕西省榆林地区第二医院放射科（７１９０００）柳宇祥患儿，女，５岁。足月顺产，产后即发现呼吸快，哭闹及吮吸奶未见明显紫绀。平时易患上感。经常有发热、咳嗽、喘息病史。当地Ｂ超诊断为先天性心脏病，室间隔缺损。查体胸廓对称，心前区...     

Spontaneous closure of a coronary artery fistula in childhood

Summary An infant with a symptomatic coronary artery fistula, documented by angiography, is presented. By age 5 years, clinical evidence of the fistula was no longer present. Repeat cardiac catheterization confirmed spontaneous closure of the coronary artery fistula. More information regarding the natural history of a coronary artery fistula is required before an elective surgical approach can be recommended in all asymptomatic children. Supported in part by Research Grants from the National Institute of Health. Training Grant HL 07413-03     

不同类型先天性冠状动脉瘘介入治疗随访研究

目的 评价儿童不同类型冠状动脉瘘(CAF)介入封堵治疗的近中期疗效、并发症及抗凝治疗方案。方法 回顾性分析2006 年1 月至2014 年1 月行CAF 介入封堵治疗的12 例患儿术前、造影及术后随访资料,记录不同类型CAF 的封堵方式、抗凝方案、术后并发症、辅助检查结果。结果 本组患儿年龄1~158 个月;近端型/中型4 例,近端型/大型5 例,远端型/中型3 例,均成功封堵;术后随访3.5±2.4 年;11 例患儿术后口服阿司匹林6 个月,1 例口服18 个月;无血栓、介入并发症,术后左心室射血分数、心胸比、肺动脉压下降,病变冠状动脉开口直径减小。结论 儿童期介入封堵治疗近端型和远端型/中型CAF 近中期疗效、安全性满意;术后阿司匹林抗凝治疗可预防近中期血栓事件,但疗程和安全性有待进一步随访研究。     

Failure of color flow mapping to identify coronary artery to pulmonary artery fistula

Summary A case of coronary artery to pulmonary artery fistula presented with the typical clinical findings of asymptomatic precordial continuous murmur and small left-to-right shunt. Echocardiography with color flow mapping failed to demonstrate the fistula on three occasions, including one study performed after angiographic demonstration of the fistula site. This case illustrates the importance of angiography in patients with unexplained continuous murmurs, even when echocardiographic and color flow mapping results are normal.     

儿童先天性肺动脉吊带临床特征及预后危险因素

目的分析儿童先天性肺动脉吊带(PAS)的临床和影像学特征,探讨其诊治策略及影响预后的危险因素。方法对2011年1月至2018年10月广州医科大学附属广州市妇女儿童医疗中心收治的98例PAS患儿的临床表现、影像学特征、治疗方式及预后进行回顾性总结和分析。结果1.共纳入98例患儿,其中男56例,女42例;起病年龄0~19个月,中位数2个月;诊断年龄0~84个月,中位数4个月。2.临床表现主要为咳嗽(61/98例,62.24%),喘息(47/98例,47.96%),气促(43/98例,43.88%),发绀(19/98例,19.39%),喉鸣(8/98例,8.16%)等。3.共96例行心脏超声检查,诊断阳性84例(87.50%),合并其他先天性心血管畸形62例(62/96例,64.58%),其中以房间隔缺损最为常见(32/96例,33.33%)。4.共92例患儿行胸部CT及三维重建检查,诊断率为100.00%,呼吸道狭窄以气管中下段为主(76/92例,82.61%),支气管桥13例(13/92例,39.13%)。77例患儿行支气管镜检查,发现完全性气管软骨环43例(43/77例,55.84%),气管支气管软化13例(13/77例,16.88%)。5.其中67例行左肺动脉(LPA)重建术,术后死亡5例,均死于术后并发症难以撤机(1例单纯行LPA重建术,余4例均有气管手术干预),失访24例,存活38例,随访2~96个月,呼吸道症状均较术前改善;31例非手术治疗,死亡18例,失访7例,余6例随访中仍有不同程度的呼吸道症状。6.多因素回归分析显示,保守治疗是影响PAS患儿预后的独立危险因素(OR=7.45,95%CI:1.23~48.68)。结论心脏超声、胸部CT及支气管镜检查三者结合更有利于PAS的诊断。LPA重建术是治疗PAS的主要手段,可改善多数患儿呼吸道症状,并气管干预术者死亡风险大。保守治疗是影响PAS患儿预后的独立危险因素。     

Coronary artery anomalies and clinically important anatomy in patients with congenital heart disease: multislice CT findings

In patients with congenital heart disease, coronary artery anomalies are common and have different clinical importance from individuals with structurally normal hearts. Visibility of the coronary arteries by CT has markedly improved due to high temporal resolution and ECG-synchronized data acquisition. In this article we describe current multislice CT techniques for coronary artery imaging and illustrate coronary artery anomalies and clinically important coronary artery anatomy from the point of view of congenital heart disease.     

Coronary artery fistula complicating the evaluation of Kawasaki disease

Summary Two patients clinically diagnosed with Kawasaki disease were found to have a coronary artery to pulmonary artery fistula. The dilemma of deciding the etiology of coronary artery dilatation in these patients is discussed along with management.     

Congenital left coronary artery — right ventricular fistula

ABSTRACT. The case of a neonate with heart failure and myocardial ischaemia due to a large coronary artery fistula is reported. ECG monitoring and Thallium — 201 imaging indicated pre-operative myocardial ischaemia. The diagnosis was confirmed by cardiac catheterization. Successful surgical ligation of the fistula was performed at the age of 10 days and to our knowledge is the first successful ligation in the neonatal period. Follow up Thallium — 201 imaging was normal. Repeat cardiac catheterization demonstrated complete closure of the fistula and normal left ventricular function.     

Innominate artery enlargement in congenital arteriovenous fistula with subsequent tracheal compression and stridor

To demonstrate that airway obstruction may be the first manifestation of a congenital fistula, a female newborn is reported who presented with increasing stridor during her first 23 months of life. Magnetic resonance imaging and Doppler echocardiography revealed an enlarged innominate artery with turbulent flow. Angiography demonstrated an arteriovenous fistula between the right subclavian artery and right subclavian vein and an abnormal origin of the right internal thoracic artery. Bronchoscopy showed a pulsating compression of the middle section of the trachea. Closure and division of the fistula and aortotruncopexy were performed. The stridor disappeared, and there was marked relief of the tracheal obstruction, confirmed by bronchoscopy. It is concluded that, a search for enlarged vessels is necessary in cases of airway obstruction.     

Percutaneous transcatheter occlusion of coronary artery fistulas using detachable balloons

Three pediatric patients underwent successful transcatheter coronary artery fistula occlusion using the Debrun system. This latex balloon system offers several advantages over other occlusion systems. First, the balloon delivery and release is controlled. Second, “test occlusions” can be performed that allow simultaneous balloon inflation, coronary cineangiography, and electrocardiographic monitoring. Third, because the balloons are flow-directed, they are easily positioned in properly chosen locations. Finally, the balloons can be constructed to suit the size of the fistula. In this study, two patients received only one balloon; in the other patient two balloons were placed in the same fistula. All fistulas drained into either the right atrium or ventricle and were successfully occluded. After a follow-up period of up to 3 years, no local or systemic reactions to the balloons were recognized. We conclude that detachable balloon occlusion of coronary artery fistulas is a safe, effective alternative to surgical ligation in selected pediatric patients.