经导管介入法治疗小儿先天性冠状动脉瘘9例

目的探讨经导管介入法治疗小儿先天性冠状动脉瘘的方法及效果。方法广东省人民医院2002年1月至2005年1月收治的先天性冠状动脉瘘患儿9例,先行心导管检查及选择性冠状动脉造影,显示瘘管的形态及引流情况,建立达到或通过瘘管欲堵闭处的输送轨道。6例瘘管最窄处内径≤3mm的病例选用可控弹簧圈进行堵闭,3例内径>3mm的病例应用Amplazter动脉导管堵闭器进行堵闭。结果8例堵闭成功,1例瘘管扭曲严重的病例堵闭失败而行外科手术。全部病例随诊2个月至3年,随诊中无并发症发生。结论经导管介入治疗冠状动脉瘘是一种创伤性小、疗效确切的方法,但必须严格掌握介入治疗适应证。

Transcatheter closure of congenital coronary artery fistula with coil and Amplazter duct occluder in children

Objective To explore the transcatheter closure method and its effect on congenital coronary artery fistular(CAF) in children.Methods There were 9 children with CAF who received transcatheter closure.Under heavy sedation,heart catheterization and selective coronary arteriography were performed to show the morphous,size and relationship with normal coronary artery of fistula.Put transport sheath to or through the closure target region of CAF.Fistula with the narrowest inner diameter<3mm was occluded with coil device in 6 cases,and fistula with narrowest inner diameter>3mm closed with Amplazter duct occluder in other 3 cases.Results Transcatheter closure was successful in 8 cases and failed in 1.The fistula of failed cases was too contorted to place the suitable occlude device.During the follow-up period of 2 months to 3 years,no residual shunt or other complications appeared.Conclusion Transcatheter closure of CAF is an effective and mini-traumatic method.To avoid complications,indications of interventional therapy must be obeyed.