Transcatheter closure and follow-up data of 25 children with congenital coronary artery fistula
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摘要: 目的:通过总结25例儿童先天性冠状动脉瘘的介入治疗及随访资料,探讨冠状动脉瘘的介入治疗方案。方法:2011年3月—2020年4月共有25例儿童先天性冠状动脉瘘患者在我院经导管介入治疗,其中3例左心室瘘,1例双冠-右室瘘,其余均为单支冠状动脉右心瘘。对其临床资料、手术过程及随访资料进行回顾性分析总结。结果:22例冠状动脉瘘患儿成功接受介入封堵治疗,并封堵成功。使用封堵材料情况:动脉导管未闭(PDA)封堵器6个、室间隔缺损(VSD)封堵器10个、二代PDA封堵器(ADOⅡ封堵器)6个。1例术后3 h突发尖端扭转室性心动过速,电复律后恢复;1例术后当日胸痛、肌钙蛋白明显升高、ST段改变,后渐恢复;余病例无不适。随访1个月至9年不等,至今无胸痛及ST段改变,未发生封堵器脱落、血栓、瘘管再通等并发症。结论:经导管介入治疗冠状动脉瘘是有效的治疗办法,且随着技术的进步,越来越多的冠状动脉瘘可经导管介入治疗。但对瘘管残端,如何预防血栓形成尚无统一规范,仍需更多的临床病例资料提供参考。Abstract: Objective: To explore the experience of transcatheter closure of coronary artery fistula by summarizing the transcatheter closure and follow-up data of 25 children cases with congenital coronary artery fistula. Method: From March 2011 to April 2020, a total of 25 children with congenital coronary artery fistula underwent transcatheter closure in our hospital, including 3 cases with left ventricular fistula, 1 case with double coronary right ventricular fistula, and 21 cases with single coronary artery right atrium or right ventricle fistula. The clinical data, transcatheter closure and follow-up data were retrospectively summarized and analyzed. Result: A total of 22 cases successfully received transcatheter closure, including 6 cases with patent ductus arteriosus(PDA) occluders, 10 cases with ventricular septal defect(VSD) occluders, and 6 cases with second-generation PDA occluders(ADOⅡ occluders). One case developed torsion de pointes ventricular tachycardia within 3 hours after the operation and recovered after electrical cardioversion; one case had chest pain, markedly elevated troponin, and ST-segment changed the day after the operation, and then gradually recovered; the remaining cases had no clinical symptoms. During the follow-up ranged from 1 month to 9 years, no complications such as chest pain, ST-segment change, shedding of the occluder, thrombus, and fistula recanalization occurred.Conclusion: Transcatheter closure of coronary artery fistula is an effective treatment. With the advancement of technology, more and more coronary artery fistula can be treated by transcatheter closure. However, there is no uniform standard on preventing thrombosis of the fistula stump, and more clinical case data are still needed.
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Key words:
- coronary artery fistula /
- children /
- transcatheter closure
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