摘要
目的 总结 5 2例先天性冠状动脉瘘的外科治疗效果。方法 全组 5 2例中 ,年龄 9个月～ 5 8岁 ,平均 (15 7± 16 4)岁。 36例为单纯的先天性冠状动脉瘘 ,16例合并有其他心脏外科疾病。5 2例中 ,右冠状动脉瘘占 71 2 % ,左冠状动脉瘘占 2 8 8%。瘘口于右室 ,右房 ,左室 ,左房及肺动脉分别为 42 3% ,30 8% ,11 5 % ,5 8%和 9 6 %。结果 手术均在体外循环下进行 ,10例切开冠状动脉闭合瘘口 ,2 6例经心腔闭合瘘口 ,16例分别闭合在冠状动脉内和在心腔内的瘘口 ;16例合并其他心脏病变同期矫治。心腔内发现二个瘘口者有 6例 ,三个瘘口者 3例 ,余 43例为单一瘘口。全组无死亡及残余漏。 37例随防 1个月～ 8年 ,平均 3 5年 ,均无症状。一例有ST T改变。结论 外科治疗先天性冠状动脉瘘是安全和有效的方法 ,合并有其他心脏外科疾病应同时矫治。准确判断瘘口的位置和确切可靠的缝合技术是防止残余漏的关键。
Objective To report surgical treatment of congenital coronary artery fistulas (CAF) in 52 patients between May 1988 and July 1997. Methods Fifty two patients ranged from 9 months to 58 years (mean 15 7±16 4 years) were operated. There were 36 patients without other coexisting cardiac defects, 9 of them over 20 years old were symptomatic, while only one less than 20 years old had clinical findings before operation. Sixteen patients associated with other cardiac lesions. The fistulae originated from right coronary artery in 37 patients (71 2%), and from left coronary artery system in 15 patients (28 8%). The sites of CAF drainage were to right ventricle, right atrium, left ventricle, left atrium and pulmonary artery in 22 (43 3%), 16(30 8%), 6(11 5%), 3(5 8%) and 5(9 6%) patients respectively. Results Correction under cardiopulmonary bypass was done in all patients with no mortality. The proximal opening of a fistula was closed through an arteriotomy on the anomalous coronary artery in 10 patients. Closure of the distal opening of a fistula draining into a cardiac chamber or the pulmonary artery was performed in 26 patients. In 16 patients, both the proximal and distal opening were closed. Two and 3 distal openings of a fistula were found in 6 and 3 patients respectively. The mean diameter of fistulas in 43 patients with single ostium was 7 34±4 12 mm (2 15 mm). No residual shunt was found at discharge from the hospital. Thirty seven patients were followed up for a mean period of 3 51±1 72 years (1 month 8 years). There were no clinical symptoms in all patients during follow up. ST T change persisted in one patient. Conclusion Early surgical management is a safe and effective treatment for congenital coronary fistula. Accurately locating and closing of the opening of CAF is the key point to prevent residual shunt. Other associated cardiac defects should be treated simultaneously.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2000年第6期455-457,共3页
Chinese Journal of Cardiology
关键词
先天性冠状动脉瘘
外科手术
临床研究
Heart defects, Congenital
Cardiovascular surgical procedures
