彩色多普勒超声心动图评价法洛四联症术后小冠状动脉-右心室瘘

目的应用彩色多普勒超声观察法洛四联症术后小冠状动脉右室瘘的发生率，探讨其发生机制并评价其预后。方法接受法洛四联症根治术患者40例，根据其狭窄部位不同分为：右室漏斗部狭窄(伴有或不伴有肺动脉狭窄)35例，单纯肺动脉狭窄5例。比较术前及术后1周内彩色多普勒超声检查结果，观察术后发生的小冠状动脉-右室瘘，并随访其转归。结果40例患者中共7例术后发现小冠状动脉右室瘘，发生率17．5％。7例患者术前均存在右室漏斗部的肌性狭窄，而5例单纯肺动脉狭窄患者术后无小冠状动脉右室瘘发生。随访中，3例患者小冠状动脉右室瘘在术后3个月内消失，其余4例在半年内消失，7例患者均无其他并发症发生。结论法洛四联症术中切除右室肥厚心肌患者，术后部分会出现小冠状动脉-右室瘘，其对心内血流动力学无明显影响。彩色多普勒超声心动图是评价法洛四联症患者术后小冠状动脉右室瘘的敏感方法。

Study on small coronary artery to right ventricular fistula after surgical repair of tetralogy of Fallot with color Doppler flow imaging

Objective To study the incidence of small coronary artery to right ventricular fistula after surgical repair of tetralagy of Fallot and investigate its possible mechanism and prognosis. Methods Forty patients with tetralogy of Fallot successfully received total repair in our hospital,including 35 patients with right ventriclar outlet tract obstructions (combined with pulmonary artery stenosis or without pulmonary artery stenosis) and 5 patients with only pulmonary artery stenosis. By using color Doppler flow imaging,the postoperative small coronary artery to right ventriclar fistula and its long-term result and the follow-up time were investigated. Results Postoperative small coronary artery to right ventriclar fistula occurred in seven cases ( 17.5 %). With the follow-up echocardiographic examination,this fistula disappeared during three months after surgery in 3 cases and six months after surgery in the rest 4 cases. All these seven cases had right ventricular outlet tract stenosis caused by hypertrophic muscles before surgery and right ventricular myectomy was processed. In the follow-up time,none had other complications. Conclusions After the resection of hypertrophic muscles of right ventricule in surgery repair of tetralogy of Fallot,postoperative small coronary artery to right ventricular fistula will occur in some patients,it has no significant influence on cardiac blood dynamics. Color Doppler flow imaging is a sensitive and important method to detect the follow-up fistula.