经心导管法封堵冠状动脉瘘的临床分析

目的探讨经心导管法封堵先天性冠状动脉瘘的技术方法、疗效和安全性。方法对6例先天性冠状动脉瘘患者进行了经心导管法封堵治疗，其中男2例，女4例，年龄5—39岁(平均14．4岁)。选择性主动脉和冠状动脉造影见右冠状动脉右室瘘3例，右冠状动脉右房瘘1例，左冠状动脉右房瘘2例。结果采用pfm弹簧圈和COOK弹簧栓子堵塞3例，Amplatzer蘑菇伞封堵3例，均获成功。3例直接将封堵器封堵瘘口；另外3例用260cm交换导丝经导管通过瘘口至右心房，用网套导管套住交换导丝并拉出股静脉，送人传送器至瘘口上方，选择不同的封堵器封堵，观察心电图正常，重复主动脉造影或冠状动脉造影无分流后释放。结论冠状动脉瘘已往均采用外科手术修复，我们选用可控弹簧圈和Amplatzer蘑菇伞封堵获得成功，提示介入疗法具有较高的治愈性，操作安全，疗效可靠。

Clinical analysis of percutaneous transcatheter closure of coronary artery fistuLa

Objective To analyze the operative procedure, efficacy and safety of percutaneous transcatheter closure in patients with congenital coronary artery fistula. Methods Percutaneous transcatheter closures of congenital coronary artery fistula were undertaken in 6 patients. Among them, there were 2 males and 4 females. The age range was 5 to 39 (mean 14.4 ) years old. Three fistulas were from the right coronary artery to the right ventricle, one from the right coronary artery to the right atrium, two from the left coronary artery to the right atrium. The vessels ranged in diameter from 7 mm to 12 mm. The diameter of the fistula site of entry into the right side of the heart ranged from 3 mm to 7 mm. Amplatzer duct occluder and pfm coils were used in 3 patients for closuring the fistulas, respectively. Results Complete occlusion was achieved in 6 patients. The device was positioned and deployed via the venous system in 3 patients, using a guidewire that had been advanced via the aorta, coronary artery, and fistula to the right atrium, snared with the venous catheter and pulled out at the femoral vein site. Three fistulas were closed via the artery system. Follow-up studies after occlusion noted normal in all patients during of 3 to 32 months. Conclusion Percutaneous transcatheter closure of coronary fistulas appears to be simple, facile, and effective. Owing to various coronary fistula morphologies, transcatheter occlusion requires availability of different embolization techniques. Short-term follow-up supports persistent clinical efficacy and transcatheter closure techniques as the initial form of therapy.