冠状动脉瘘的诊断及治疗方法探讨

目的探讨冠状动脉瘘(CAF)的诊断及治疗方法。方法16例冠状动脉瘘患者，经彩色多普勒超声检查14例，确诊12例，升主动脉及冠状动脉造影检查4例均确诊。16例患者均行手术治疗．其中非体外循环下行缝扎瘘口1例，体外循环下经心腔内闭合瘘口12例，切开冠状动脉闭合瘘口1例，分别闭合冠状动脉内瘘和心腔内瘘口2例；同期行冠状动脉旁路移植术1例，室间隔缺损修补1例。结果手术发现单一瘘口11例，两个瘘口5例。全组无死亡病例及并发症发生。术后随诊无残余瘘发生。结论选择性冠状动脉造影检查是诊断CAF的金标准；CAF自行闭合性小，一旦确诊，即使无症状也应及早手术治疗。手术宜在体外循环下进行，准确判断漏口位置和精确缝合是手术成功的关键。

Diagnosis and surgical treatment of coronary artery fistulas

Objective To study the diagnosis and surgical treatment of coronary artery fistulas (CAF).Methods 16 patients were with CAF diagnosed by colour Doppler ultrasonic and selective coronary angiog-raphy.Cardiopulmonary bypass was used in 15 patients and off-pumping in 1 patients.The distal opening of a fistula was closed within the dilated coronary artery in 1 patient and through the cardiac chamber in 12 patients.In 2 patients,both the proximal and distal opening were closed.One patient had associated with coronary artery bypass grafting and other patient had associated with repairing of ventricular septal defect.Results Two and single distal fistulas were found in 5 and 11 patients,respectively.No patient died and no complication happened.No residual shunt was found before patients were discharged from the hospital Conclusions Preoperative selective coronary angiography is the golden standard for the CAF diagnosis.Because the ability of spontaneous occlussion of CAF is little,surgical treatment should be given even in asymptomatic patients.The operation should do under cardiopulmonary bypass and the key of successful operation is the nicety of judgment on fistula position and the exactitude sewing fistula.