经胸超声心动图在小儿冠状动脉瘘诊疗中的应用

目的探讨经胸超声心动图(TTE)在小儿冠状动脉瘘(CAF)诊疗中的价值。方法回顾性分析27例小儿CAF患者,分析其临床症状、TTE检查结果、其他影像学检查结果、治疗方案及随访情况。结果27例CAF患者中,74.07%(20/27)有心脏杂音,14.81%(4/27)有临床症状。7.41%(2/27)出现左心室射血分数减低。55.56%(15/27)的CAF为单纯型;62.96%(17/27)的CAF起源于右冠状动脉,33.33%(9/27)起源于左冠状动脉,而3.70%(1/27)起源于双侧冠状动脉。CAF的瘘道出口可能出现在右心室(13/27,48.15%),肺动脉(6/27,22.22%),右心房(5/27,18.52%),左心室(2/27,7.41%)或冠状静脉窦(1/27,3.70%)。17例患者接受外科手术治疗,1例患者接受介入封堵治疗。TTE精准诊断19例CAF。对于9例接受保守治疗的患者,于诊断后1、3、5年进行随访,未发现自发性闭合、心力衰竭、感染性心内膜炎或死亡病例。结论 TTE安全、有效,可用于筛查、诊断CAF,及评价治疗效果和并发症。

Transthoracic echocardiography in diagnosis and treatment of pediatric coronary artery fistula

Objective To explore the value of transthoracic echocardiography (TTE) in diagnosis and treatment of pediatric coronary artery fistula (CAF). Methods Totally 27 pediatric patients with CAF were analyzed retrospectively, and the following data were collected, included symptoms, the findings of TTE, other imaging, treatment strategy and the result of follow-up visit. Results In 27 pediatric patients, 74.07% (20/27) patients had murmurs and 14.81% (4/27) had symptoms, 7.41% (2/27) patients were associated with ejection fraction descending, 55.56% (15/27) patients had isolated fistula. Fistula originating from the right coronary artery (RCA) accounted for 62.96% (17/27), with 33.33% (9/27) from the left coronary artery (LCA), 3.70% (1/27) from both coronary arteries. The fistula might drain into the right ventricle (13/27, 48.15%), the pulmonary artery (6/27, 22.22%), the right atrium (5/27, 18.52%), the left ventricle (2/27, 7.41%) or the CS (1/27, 3.70%).And 17 patients received surgery and 1 received transcatheter closure, 19 cases were correctly and accurately diagnosed by TTE. The follow-up were performed on 9 cases underwent conservative treatment the first, third and fifth year after diagnosis. During the follow-up of patients with conservation treatment, there was no spontaneous closure, heart failure, infective endocarditis or death. Conclusion TTE can be used to screening and diagnose pediatric patients with CAF safely and effectively, and it is helpful for the evaluation of the effect of surgery and postoperative complications.