Short and medium-term surgical treatment effects of congenital coronary artery fistula
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摘要: 目的:探讨先天性冠状动脉瘘手术治疗的最佳时机、方法及疗效,努力提高手术成功率。方法:我院2013年10月-2019年10月共收治19例冠状动脉瘘患者,其中男11例,女8例,年龄4.5(1~61)岁,体重16.25(7~69) kg。右冠状动脉右房瘘3例,右冠状动脉右室瘘7例,右冠状动脉左室瘘1例,左冠状动脉右房瘘2例,左冠状动脉左房瘘2例,左冠状动脉右室瘘2例,左冠状动脉肺动脉瘘2例;合并先天性二尖瓣发育不良2例,房间隔缺损、室间隔缺损、卵圆孔未闭、三尖瓣关闭不全各1例。所有患者均胸正中切口体外循环下行动脉瘘矫治术,同期矫治其他心脏畸形,围术期常规监护治疗,术后1、6个月及每年随访复查。对所有患者临床资料进行统计、分析及总结。结果:升主动脉阻断时间(61.330±11.479) min,体外循环时间(99.940±15.206) min,手术时间(140.610±19.150) min,呼吸机使用时间(33.000±19.275) h,ICU时间(2.220±1.215) d,住院时间(20.940±8.795) d。患者术前左室射血分数(63.167±8.031)%,术后当日左室射血分数(69.390±8.389)%,术后左室功能明显改善(P<0.05)。患者术前心胸比0.506±0.0769,术后当日心胸比0.479±0.060 3,手术前后心胸比差异显著(P<0.05)。19例患者围手术期无严重并发症及死亡,均痊愈出院。术后随访6个月~5年,未见残余瘘及严重心血管症状。结论:冠状动脉瘘发病率低,出现心悸、呼吸困难等症状应尽早手术治疗,外科手术治疗疗效较好,并发症少。Abstract: Objective: To summarize clinical experiences and surgical outcomes of congenital coronary arterial fistula(CAF),and to provide evidence for surgical decision and postoperative recovery and improving the success rate of surgery.Method: We retrospectively analyzed clinical records of 19 patients who underwent surgical repair of CAF in our center from October 2013 to October 2019,including 11 males and 8 females.The median age was 4.5(1-61) years,and the median weight was 16.25(7-69) kg.There were 3 cases with right coronary artery-right atrial fistula,7 cases with right coronary artery-right ventricular fistula,1 case with right coronary artery-left ventricular fistula,2 cases with left coronary artery-right atrial fistula,2 cases with left coronary artery-left atrial fistula,2 cases with left coronary artery-right ventricular fistula,and 2 cases with anomalous left coronary artery from the pulmonary artery.Two patients complicated with congenital mitral valve dysplasia,1 case complicated with atrial septal defect,1 case complicated with ventricular septal defect,1 case complicated with patent foramen ovale,and 1 case complicated with tricuspid insufficiency.All patients underwent CAF correction under cardiopulmonary bypass through thoracic median incision,and other cardiac malformations were corrected at the same time.Routine monitoring and treatment were performed in the perioperative period,1 month,6 months, and annual follow-up after operation were conducted.The clinical data of all patients were statistically analyzed and summarized.Result: The aortic cross-clamping time was(61.33±11.479) min,the cardiopulmonary bypass time was(99.94±15.206) min,the operation time was(140.61±19.150) min,the intubation duration was(33±19.275) h,the length of ICU stay was(2.22±1.215)d,and the length of hospital stay was(20.94±8.795)d.The preoperative left ventricular ejection fraction(LVEF)was(63.167±8.031)%,the postoperative LVEF was(69.39±8.389)%,and the postoperative left ventricular function were significantly improved(P<0.05).The preoperative cardiothoracic ratio was 0.506±0.0769,and the postoperative cardiothoracic ratio was 0.479±0.060 3,and the difference was statistically significant(P=0.006<0.05).No death was found during the perioperative period,all patients were recovered and discharged.Followed up for 6 months to 5 years,no severe cardiovascular symptoms related to residual fistula was found.Conclusion: The incidence of CAF is low.A few patients can appear palpitations,breathing difficulties and other symptoms,which should be operated as soon as possible.Surgical treatment is effective and has less complications.
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Key words:
- coronary artery fistula /
- surgical treatment /
- prognosis
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[1] Proudfit WL,Shirey EK,Sones FM,et al.Selective cine coronary arteriography.Correlation with clinical findings in 1,000 patients[J].Circulation,1966,33(6):901-910.
[2] Erdogan E,Cap M,Topel C,et al.Coronary artery fistula detected with transesophageal echocardiography:An unexpected cause of pulmonary hypertension and chest pain[J].Echocardiography,2018,35(12):2127-2129.
[3] Jiang Y,Liu P,Cao Y.Preoperative evaluation of coronary artery fistula using dual-source computed tomography[J].Int J Cardiol,2017,234:117.
[4] 骆磊,朱郧鹤,孙鹏,等.先天性冠状动脉瘘结扎术后的随访及CT表现[J].中国医学影像学杂志,2019,27(1):15-19.
[5] Bolukcu A,Topcu AC,Sensoz Y,et al.Coronary artery fistulae involving both right and left coronary arteries[J].Ann Thorac Surg,2017,103(3):e261-e262.
[6] 王燕飞,张丽,黄萍,等.儿童孤立性冠状动脉瘘的治疗及中期随访分析[J].临床小儿外科杂志,2020,19(1):54-58.
[7] Fan C,Tang M,Yang J.right coronary artery fistula into left ventricle:blood flow steal phenomenon[J].Ann Thorac Surg,2017,103(3):e287.
[8] 王洪雨,孙成建.先天性冠状动脉瘘的治疗争议[J].临床心血管病杂志,2017,33(3):283-286.
[9] Mangukia CV.Coronary artery fistula[J].Ann Thorac Surg,2012,93(6):2084-2092.
[10] Matsumoto Y,Kawano H,Iwasaki K,et al.histopathology of giant coronary artery aneurysm associated with coronary artery fistula[J].Int Heart J,2018,59(2):431-434.
[11] Huang Z,Liu Z,Ye S.The role of the fractional flow reserve in the coronary steal phenomenon evaluation caused by the coronary-pulmonary fistulas:case report and review of the literature[J].J Cardiothorac Surg,2020,15(1):32.
[12] Duan S,Shi Y,Zhang X,et al.Right coronary artery-right ventricular fistula complicated with infective endocarditis[J].Echocardiography,2020,37(2):356-358.
[13] Gowdar M,Vasavada BC,Khan IA,et al.Coronary artery fistulas:clinical and therapeutic considerations [J].Int J Cardiol,2006,107(1):7-10.
[14] Warnes CA,Williams RG,Bashore TM,et al.ACC/AHA 2008 guidelines for the management of adults with congenital heart disease:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease)[J].Circulation,2008,118(23):2395-2451.
[15] Uzuka T,Nakamura M,Nakajima T,et al.Surgery of giant right coronary artery aneurysm complicated with coronary artery fistula to left ventricle[J].J Card Surg,2018,33(2):95-96.
[16] 郭馨馨,杨芳,谢琦,等.儿童先天性冠状动脉瘘18例临床分析[J].福建医药杂志,2019,41(5):24-27.
[17] Challoumas D,Pericleous A,Dimitrakaki IA,et al.Coronary arteriovenous fistulae:a review[J].Int J Angiol,2014,23(1):1-10.
[18] Newburger JW,Takahashi M,Gerber MA,et al.Diagnosis,treatment,and long-term management of Kawasaki disease:a statement for health professionals from the Committee on Rheumatic Fever,Endocarditis and Kawasaki Disease,Council on Cardiovascular Disease in the Young,American Heart Association[J].Circulation,2004,110(17):2747-2471.
[19] Uchida T,Hamasaki A,Sadahiro M.Intraoperative fluorescence-guided imaging for coronary artery fistula[J].Eur J Cardiothorac Surg,2018,53(1):290.
[20] Song G,Ren W,Tang L,et al.Coronary artery fistula from the left circumflex to coronary sinus in infant:Case report with literature review[J].Int J Cardiol,2015,188:37-39.
[21] Herbert CE,Stapleton GE.Percutaneous device closure of a large?coronary artery fistula post-right ventricular endomyocardial biopsy in a pediatric patient[J].JACC Cardiovasc Interv,2019,12(9):e75-e77.
[22] Folino G,Bernardinello V,Carrozzini M,et al.Transfemoral aortic valve replacement as a solution in aortic valve stenosis and coronary artery fistulas[J].J Thorac Cardiovasc Surg,2019,S0022-5223(19)30920-30921.
[23] Song L,Dong Y,Wang B,et al.The evolution of the minimally invasive approach and conventional median sternotomy for coronary artery fistula correction[J].Heart Lung Circ,2019,28(8):1277-1282.
[24] Van Loo I,Sonck J,Tanaka K,et al.Thoracoscopic off-pump closure of a large left circumflex coronary artery fistula:A novel minimally invasive approach[J].J Thorac Cardiovasc Surg,2018,156(4):e159-e161.
[25] Zhang J,Ma W,Zhang W,et al.3-dimensional printed models-guided surgical repair for recurrent coronary artery fistula[J].Ann Thorac Surg,2019,107(3):e161-e163.
[26] 邱海龙,庄建,岑坚正,等.虚拟现实技术在冠状动脉瘘和冠状动脉异常起源外科诊疗中的应用价值[J].中国胸心血管外科临床杂志,2019,26(3):1-5.
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