摘要
目的 总结成人先天性冠状动脉瘘 (CAF)的临床特点、诊断和外科治疗经验。 方法回顾性分析 1985年 3月～ 2 0 0 2年 4月间我院外科治疗的 14例成人CAF的临床资料。其中男 8例 ,女6例 ;平均年龄 ( 32± 13)岁 ;有症状者 11例。本组患者术前经超声心动图或心导管造影检查明确诊断。右冠状动脉 心腔瘘 10例 ( 71% ) ,其中瘘口位于右心室 6例、左心室 3例、右心房 1例 ;左冠状动脉 心腔瘘 3例 ( 2 1% ) ,其中瘘口位于右心室 2例、左心室 1例 ;双冠状动脉 肺动脉瘘 1例 ( 7% )。瘘口为单个 12例 ,多个 2例 ;瘘口直径 0 30～ 1 80cm ,平均 ( 1 16± 0 49)cm。合并冠状动脉瘤 6例、其他心血管病变 4例。CAF瘘口在体外循环下闭合 10例 ,非体外循环下直接结扎或缝扎 4例。合并病变同期处理。 结果 全组患者无早期死亡。长期随访 12例 ( 85 71% ) ,平均随访时间 ( 3 35± 4 2 8)年。患者无心肌缺血或梗死、残余瘘和晚期死亡。心功能恢复至Ⅰ级 11例、Ⅱ级 1例。 结论 成人CAF已存在明显的血液动力学和心血管形态学改变 ,应尽早手术治疗。合适的手术方法和确实的心肌保护是取得良好外科手术疗效的关键。
Objective To summarize the clinical characteristics, diagnosis and surgical intreatment results of congenital coronary artery fistulas(CAF) in adults. Methods Fourteen patients (8 men, 6 women), aged from 18 to 60 years with a mean of 32±13 years, underwent surgical correction of CAF between March 1985 and April 2002. Eleven of the 14 patients (78.57%)were symptomatic. The diagnosis of CAF was made by echocardiography or angiocardioraphy preoperatively. The fistulae originated from the right, left and double coronary arteries in 10(71%),3(21%)and 1(7%)patient(s), respectively. The fistulae drained into the right ventricle( 8 patients), left ventricle(4), right atrium(1) and pulmonary artery(1), respectively. The diameter of fistulae ranged from 0.30 to 1.80 cm with a mean of (1.16±0.49) cm. There were 6 CAF patients associated with coronary artery aneurysms and 4 CAF patients with other coexisting cardiac defects. The distal fistulae were closed in 10 patients with cardiopulmonary bypass (CPB) and 4 patients without CPB. The coexisting defects were corrected simultaneously. Results There was no early and late death. One patient had low cardiac output syndrome and cured during early postoperative period. Twelve patients(85.71%)were followed up for amean period of 3.35±4.28 years without myocardial ischemia or infarction and recurrent fistulae. Heart function was improved to NYHA functional class Ⅰ in 11 patients and class Ⅱ in 1 patient. Conclusions All adult patients with CAF who have demonstrable hemodynamic and cardiovascular morphological changes should be surgically treated as early as possible. The appropriate surgical management and reliable myocardial protection are key points of good surgical results.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2003年第1期41-43,共3页
Chinese Journal of Surgery
关键词
冠状血管畸形
血管瘘
诊断
外科手术
Coronary vessel anomalies
Vascular fistula
Diagnostic techniques, cardiovascular
Cardiovascular surgical procedures
