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。

Clinical analysis of transcatheter closure of coronary artery fistula in middle and aged patients

Objective:To analyze the effectiveness and feasibility of transcatheter closure in middle age and aged patients with congenital coronary artery(CA) fistula. Method:seven patients (3 males, 4 females) with average of 48 years with coronary artery fistula undergoing percutaneous transcatheter closure were enrolled. Seven fistulas consisted of 3 CA-pulmonary, 3 CA-atrium and 1 CA-ventricle. Coils were advanced to proximal-middle segment of fistula through microtube delivery system which was positioned at middle situ if the diameter of fistula <8 mm. For large fistula with diameter >8 mm, Amplatzer ductus occluder(ADO) was used alternatively. Stent graft was choosed if ostial fistula unsuitable for coils or ADO. Result:Three fistulas were successfully occluded by coils, 1 by ADO and 2 by stent graft. Dissection at proximal fistula induced by guidewire occluded fistula in one patient. Re-angiogram immediately after the procedure demonstrated complete occlusion in five patients, and small residual shunt in two patients. All patients survived during 4-24 months of follow-up and did not manifest symptoms. Conclusion:Transcatheter closure of coronary artery fistulas is an effective, safe and reliable method in the middle age and aged patients.