双源CT对冠状动脉瘘手术前后的临床评估价值

［摘要］目的　探讨双源CT在冠状动脉瘘手术前后诊断中的应用价值．方法　回顾性分析15例CAF患者CT影像，其中11例行体外循环下的外科缝闭术．结果　15例中瘘支冠状动脉起源于右冠状动脉8例；左冠状动脉7例，其中3例窦房结支，2例前降支，2例回旋支；瘘口位于右房6例、右室5例、左室4例、左房1例；冠状动脉全程扩张8例、局限性动脉瘤形成4例、不扩张3例；单一瘘口 11例、多发瘘口4例．11例均在体外循环下手术．10例术后影像显示瘘口已缝补，未见残余瘘口； 3例显示瘘支血管近段结扎，1例右冠状动脉成形术仅见右冠近端显影，远端闭塞；2例假性憩室形成．结论　DSCT检查对冠状动脉瘘手术前后均有有重要的评估价值．

The Clinical Value of Dual-source CT in the Diagnosis of Coronary Artery Fistula before and after Surgery

［Abstract］Objective The aim of this study was to explore the clinical value of dual-source CT （DSCT） in the diagnosis of coronary artery fistula （CAF） before and after surgery. Methods A retrospective analysis was performed in 15 cases of patients with CAF， 11 cases of which was treated by surgery during extracorporeal circulation. Results CAF arose from right coronary artery in 8 cases and left coronary artery in 7 cases， with the latter including 3 cases of ramus nodi sinuatrialis fistula， 2 cases of anterior descending branch fistula， and 2 cases of left circumflex fistula. CAF entered into right atrium （6 cases）， right ventricle （5 cases）， left ventricle （4 cases） and left atrium （1 case）. There were dilatation of coronary artery in 8 cases， localized aneurysm in 4 cases， normal coronary artery in 3 cases， single fistula orifice in 11 cases， and multiple fistula orifice in 4 cases. 11 patients underwent surgery under cardiopulmonary bypass （CPB）.The postoperative imaging revealed fistula has been sutured in 10 patients with no residual fistula， including fistula vascular ligation in 3 cases， the proximal imaging and distal occlusion in right coronary artery angioplasty in 1 case， and pseudo diverticulum in 2 cases. Conclusion DSCT examination has significant value in preoperative diagnosis and postoperative follow-up for CAF.