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目的:总结分析34例先天性冠状动脉瘘(CAF)的临床诊断治疗与外科手术方法。方法:回顾性分析应用超声心动图、64层螺旋CT、选择性冠状动脉造影等检查确诊的34例CAF患者的临床资料,其中24例为单纯性CAF,10例合并其他心脏外科疾病。结果:34例中5例直接行动脉瘘切线缝合术,其余29例均在体外循环直视下行瘘口修补并同时矫治合并心脏疾病。心腔内发现2瘘口1例,4瘘口1例,其他均为单一瘘口。所有患者术毕效果明显,无一例死亡,超声心动图复查均无残余瘘存在。22例随访0.5~3年无死亡及并发症发生。结论:64层螺旋CT检查可准确显示各种CAF的起源、行程、引流部位及并发异常,显示冠状动脉近段管腔的形态及一些较大冠状动脉瘘,是一种较为理想的无创性诊断CAF的影像方法。CAF明确诊断后,及时行外科手术治疗安全可靠,少数患者可行介入治疗。
Objective: To summarize and analyze the clinical diagnosis and surgical treatment of 34 cases of congenital coronary artery fistula (CAF). Methods: The clinical data of 34 CAF patients diagnosed by echocardiography, 64-slice spiral CT and selective coronary angiography were retrospectively analyzed. Among them, 24 were simple CAF and 10 were combined with other cardiological diseases. Results: Of the 34 cases, 5 cases underwent tangential suture directly. The remaining 29 cases underwent fistula repair while undergoing cardiopulmonary bypass and corrected the heart disease simultaneously. One case of 2 fistula was found in the cardiac cavity, 1 case of 4 fistula and the other was a single fistula. All patients completed the operation effect is obvious, no case of death, no residual echocardiography review fistula exist. 22 cases were followed up for 0.5 to 3 years without death and complications. Conclusion: The 64-slice spiral CT can accurately show the origin, stroke, drainage site and concomitant abnormalities of various CAFs. It shows the morphology of proximal coronary lumens and some large coronary fistulas. It is an ideal noninvasive diagnosis CAF imaging method. CAF clear diagnosis, timely and safe surgical operation, a small number of patients feasible intervention.