先天性冠状动脉瘘外科治疗_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

刘刚 ¹ ,  刘志刚 ¹ , 于艾嘉 ² , 路万里 ¹

1. ;
2. ;

Corresponding author：

刘志刚, Email: liuzg@tedaich.com

Keywords：

先天性心脏病; 冠状动脉瘘; 外科手术

DOI：

10.7507/1007-4848.202002035

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目的总结外科手术矫治先天性冠状动脉瘘的临床结果及相关经验。方法回顾性分析 2010 年 1 月至 2019 年 6 月就诊于泰达国际心血管病医院的 25 例先天性冠状动脉瘘患者的临床资料，其中男 17 例、女 8 例，年龄 5 个月至 53 岁，中位年龄 5 岁。其中合并房间隔缺损 1 例，合并动脉粥样硬化 1 例。手术方式：直接缝闭瘘口 16 例，心包补片修补瘘口 9 例。1 例患者非体外循环下手术矫治；其余 24 例均在体外循环下行手术矫治，其中 2 例心脏未停跳下外科矫治。结果所有患者顺利出院，体外循环时间（59.75±22.75）min，主动脉阻断时间（34.55±13.22）min。术中探查发现均为单一瘘口。右冠状动脉-左室瘘 2 例（8.0%）、右冠状动脉-右房瘘 3 例（12.0%）、右冠状动脉-右室瘘 10 例（40.0%）、左冠状动脉-右室瘘 4 例（16.0%）、左冠状动脉-右房瘘 2 例（8.0%）、左冠状动脉-肺动脉瘘 4 例（16.0%），其中 1 例为罕见的窦房结动脉-右房瘘，窦房结动脉起自右冠状动脉。患者术后均给予阿司匹林抗血小板治疗 3 个月，其中 2 例随访中发现瘘口残端血栓形成。所有病例已扩张冠状动脉，未恢复正常内径。随访 1 个月至 3 年，无患者死亡和心肌缺血及残余瘘发生。结论有症状或者分流量明显的先天性冠状动脉瘘，应尽早手术矫治，术中根据解剖特点确定手术方式，外科手术结果满意。

Citation： 刘刚, 刘志刚, 于艾嘉, 路万里. 先天性冠状动脉瘘外科治疗. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(12): 1500-1502. doi: 10.7507/1007-4848.202002035 Copy

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1. Angelini P. Coronary artery anomalies--current clinical issues: definitions, classification, incidence, clinical relevance, and treatment guidelines. Tex Heart Inst J, 2002, 29(4): 271-278.
2. Manoly I, Mahadevan VS, Hoschtitzky JA. Hybrid approach to closure of an acquired coronary-cameral fistula. Ann Thorac Surg, 2014, 98(3): e59-e61.
3. McMahon CJ, Coleman D, Oslizlok P. Extensive coronary arterial fistula development in patients with univentricular circulation. Catheter Cardiovasc Interv, 2014, 84(5): 811-814.
4. Seltzer S, Aboulhosn J, Levi DS. Use of interlock fibered detachable coils for occlusion of collaterals, coronary artery fistulae, and patent ductus arteriosus. Catheter Cardiovasc Interv, 2009, 74(5): 770-776.
5. Dimitrakakis G, Von Oppell U, Luckraz H, et al. Surgical repair of triple coronary-pulmonary artery fistulae with associated atrial septal defect and aortic valve regurgitation. Interact Cardiovasc Thorac Surg, 2008, 7(5): 933-934.
6. Said SA, Lam J, van der Werf T. Solitary coronary artery fistulas: a congenital anomaly in children and adults. A contemporary review. Congenit Heart Dis, 2006, 1(3): 63-76.
7. Demirkilic U, Ozal E, Bingol H, et al. Surgical treatment of coronary artery fistulas: 15 years' experience. Asian Cardiovasc Thorac Ann, 2004, 12(2): 133-138.
8. Muñoz-Guijosa C, Ginel A, Leta R, et al. Giant circumflex coronary artery fistula to the superior vena cava in patient with multiple valvular disease. Ann Thorac Surg, 2008, 86(3): e3.
9. Kamiya H, Yasuda T, Nagamine H, et al. Surgical treatment of congenital coronary artery fistulars: 27 years' experience and review of the literature. J Card Surg, 2002, 17(2): 173-177.
10. Valente AM, Lock JE, Gauvreau K, et al. Predictors of long-term adverse outcomes in patients with congenital coronary artery fistulae. Circ Cardiovasc Interv, 2010, 3(2): 134-139.
11. Kabbani Z, Garcia-Nielsen L, Lozano ML, et al. Coil embolization of coronary artery fistulas. A single-centre experience. Cardiovasc Revasc Med, 2008, 9(1): 14-17.
12. Dimitrakakis G, Otto von Oppell U. eComment: Surgical treatment of coronary arteriovenous fistulas. Interact Cardiovasc Thorac Surg, 2011, 13(6): 674-675.
13. Hajj-Chahine J, Haddad F, El-Rassi I, et al. Surgical management of a circumflex aneurysm with fistula to the coronary sinus. Eur J Cardiothorac Surg, 2009, 35(6): 1086-1088.
14. Mawatari T, Koshino T, Morishita K, et al. Successful surgical treatment of giant coronary artery aneurysm with fistula. Ann Thorac Surg, 2000, 70(4): 1394-1397.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

先天性冠状动脉瘘外科治疗

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