先天性冠状动脉瘘的临床分析

史冬梅 周玉杰 赵迎新 张维君 崔卫东 陈长城 韦华  刘宇杨
100029  首都医科大学附属安贞医院
 【摘要】目的:总结61例先天性冠状动脉瘘（CAF）的临床特点及治疗疗效。方法 应用超声心动图、升主动脉造影及选择性冠状动脉造影检查确诊CAF61例，其中50例为单纯性CAF，12例伴随其他先天性畸形。起源于左冠状动脉26例（42.5%），右冠状动脉29例（57.5），双侧无明显差异,但80％以上的患者引流至右心系。结果 61例冠状动脉瘘患者中8例未进行有创干预治疗；46例患者进行了外科手术治疗，治愈44例，死亡2例合并其他先天性畸形；7例行导管栓堵治疗，6例治愈，1例因导管到位困难停止手术。结论:超声心动图及选择性冠状动脉造影是冠状动脉瘘主要地的确诊手段，经导管栓堵术和外科手术闭合冠状动脉瘘安全有效，建议在症状出现前进行根治性治疗。
 【关键词】冠状动脉瘘，超声心动图，冠状动脉造影，外科手术，经导管栓堵

Clinical analysis 61 cases with coronary artery fistulas
Shi Dongmei  Zhou Yujie  Zhao Yingxin  Zhang Weijun  Cui Weidong Chen Changcheng WeiHua  Li Yueping  Liu Yuyang
  AnZhen Hospital of Capital University of Medical sciences
Beijing (100029) P R China
 [Abstract] Object: To summarize the clinical features, diagnostic method and therapeutic effectiveness of 61cases with congenital coronary artery fistula. Method: Investigated by  echocardiogram, ascending aortography and selective coronary arteriography we diagnosed 61 cases of CAF. There are 50 patients with isolated CAF and 12 patients combined with other congenital malformation. Fistulae originate from right and left coronary arteries in almost equal proportion ---29(57.5%) and 26(42.5%)respectively, but over 80% drain to the right side of the heart. Result: there are 8 patients underwent Conservative management, while 46 patients experienced surgical closure and 7 patients experienced Tran catheter embolization. There are 2 patients who suffered with complex malformation died of operative complication and 1 patient experienced unsuccessful transcatheter treatment. Conclusion: Echocardiogram, ascending aotography and selective coronary arteriography are the major approach to diagnose the CAF. Surgical closure and transcatheter embolization are save and effective treatment. We recommended that patients should be permanent control before the symptom occurred.
 [key words] coronary artery fistula   echocardiography coronary arteriography
surgical closure   transcatheter embolization