先天性冠状动脉瘘的外科治疗

目的总结外科手术治疗冠状动脉瘘的临床经验及治疗方法,以提高对该类疾病的治疗效果。方法对2001年2月至2011年11月收治的104例先天性冠状动脉瘘患者的临床资料进行回顾性分析,其中男性48例,女性56例,年龄5个月至71岁,平均年龄34岁。104例中有56例患者在非体外循环下行直接结扎及缝扎,其中微创小切口14例;48例合并其他先天畸形及心脏疾病者在体外循环下施行手术,直接结扎及缝扎瘘口,对合并的心脏畸形或疾病同期做相应的矫治。结果瘘口发生于右冠状动脉63例,发生于左冠状动脉41例,瘘人右心房21例,瘘人右心室40例,瘘人肺动脉30例,瘘人冠状静脉1例,瘘入上腔静脉1例。除1例因其他疾病死亡外,全组无手术死亡。随访2-10年,复查超声均无异常。结论先天性冠状动脉瘘可采用直接结扎及缝扎方法,部分病例可采用小切口治疗,手术效果安全有效。

Surgical treatment for patients with congenital coronary artery fistula

Objective To improve the treatment effectiveness of coronary artery fistula by summarizing and analyzing the clinical experiences of its surgical procedures. Methods The clinical data of 104 patients, 48 males and 56 females, with coronary artery fistula who were hospitalized from February 2001 to November 2011 were retrospectively analyzed. The age of the patients ranged from 5 months to 71 years old （mean age of 34 years）. 56 cases without associated intraeardiac abnormalities were given surgical closure of fistula without cardiopulmonary bypass. 14 cases were repaired by small incision. 48 cases with large size fistula were repaired directly or with a patch under cardiopulmonary bypass. Coexisted heart abnormalities were treated simultaneously. Results There were 63 cases of right coronary artery fistula, 41 cases of left coronary artery fistula, 40 cases of coronary artery fistula opening into the right ventricle 21 cases opening into the right atrium, 30 cases opening into the pulmonary artery, 1 cases opening into the sinus of coronary veins, 1 cases opening into the superior vena cava. No death happened during the operation. All patients received surgical treatment successfully. Follow up was conducted on 103 patients with the time period ranging from 2 years to 10 years. The color ultrasonic cardiography showed that all patients recovered well. Conclusion The surgical treatment of CAF is safe and efficient.