双侧冠状动脉-肺动脉瘘的冠状动脉CT成像特点

目的分析双侧冠状动脉-肺动脉瘘患者的冠状动脉成像特点,为临床治疗方案的制定提供参考。方法收集经冠状动脉CT成像检出的双侧冠状动脉-肺动脉瘘患者20例,回顾性分析其解剖特点,包括起源,瘘血管走行,瘘口位置和大小,以及有无瘤样扩张。结果 20例患者瘘血管均起源于右冠状动脉的圆锥支和左前降支的近端,走行于肺动脉主干前方,瘘口位于肺动脉主干左前缘。13例(65%)出现瘤样扩张。瘘口直径范围(0.9-7.5)mm,中位直径3.5mm。伴随瘤样扩张组和无瘤样扩张组在瘘口直径、瘘血管起源于左前降支近端的直径方面差异有统计学意义,P值分别为0.018和0.046,而在瘘血管起源于右冠状动脉圆锥支的直径方面差异无统计学意义,P值为0.291。结论 CCTA可以清晰地显示Bi-CAPF的瘘血管的解剖特点,包括起源、数量、走行、有无瘤样扩张、瘘口位置、瘘口大小等,为术前治疗方案的制定提供全面的参考信息。结论 CCTA可以清晰地显示双侧冠状动脉-肺动脉瘘的形态特征,为手术方案的制定提供全面的信息。

Findings of Bilateral Coronary Artery to Pulmonary Fistula on Coronary Computed Tomography Angiography

Objective To analyze the characteristic features of bilateral coronary artery to pulmonary fistula (Bi-CAPF) by coronary computed tomography angiography (CCTA). Methods 20 cases of Bi-CAPF were detected by CCTA. We retrospectively analyzed the anatomical characteristics, including number of origins, course, opening site and size of the fistula, and presence of aneurysmal changes. Results All the 20 cases arose from the conus branch of the right coronary and proximal left anterior descending. All Bi-CAPF coursed anteriorly to the main pulmonary artery and drained into the left anterolateral aspect. 13 cases (65%) were present with aneurysmal changes. The median size of the opening site was 3.5mm (arranged from 0.9mm to 7.5mm). The difference of the diameter of the opening site between the group with aneurysmal changes and the group without aneurysmal changes was significant (P=0.018). The difference of the diameter of the proximal of LAD between the two groups was also significant (P=0.046). The difference of the diameter of the conus branch of the RCA was not significant (P=0.291). Conclusion CCTA can clearly visualize the morphological features of the Bi-CAPF, It can be used to provide comprehensive information for determining operative strategies.