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目的:分析冠状动脉-肺动脉瘘(coronary artery-to-pulmonary artery fistula,CPAF)行经皮介入封堵治疗的可行性、安全性及疗效。方法:回顾性分析长海医院心内科于2009年7月至2016年2月之间接受经皮介入封堵术的58例CPAF患者的临床资料,排除合并其他复杂心脏病变而需要外科手术治疗的患者。结果:58名CPAF患者经介入封堵均获成功,平均植入封堵材料(2.35±0.87)枚。24名(41.38%)患者成功封堵后残余分流立即消失,34名(58.62%)患者仍有少量分流。未出现手术相关并发症。术后随访2~61个月,无出血、缺血等并发症。随访造影显示,其中3名(5.17%)患者出现了大量再通,后者随后均接受了再次封堵术并成功封堵。结论:经皮介入封堵CPAF切实可行,但应选择适宜患者,且需要经验丰富的术者操作。经治疗后冠状动脉瘘可能出现再通,因此对这些患者应进行随访造影或其他影像学检查。
Objective: To analyze the feasibility, safety and efficacy of percutaneous interventional treatment of coronary artery-to-pulmonary artery fistula (CPAF). Methods: The clinical data of 58 CPAF patients who underwent percutaneous closure in the department of cardiology of Changhai Hospital from July 2009 to February 2016 were retrospectively analyzed. Exclusion of patients complicated by other complicated heart diseases requiring surgical treatment . Results: Fifty-eight CPAF patients were successfully treated by interventional therapy, with an average of 2.35 ± 0.87 implanted materials. Twenty-four patients (41.38%) immediately disappeared after successful occlusion, and 34 patients (58.62%) still had a small amount of shunt. No surgery-related complications occurred. All the patients were followed up for 2 to 61 months without complications of hemorrhage and ischemia. Follow-up angiography showed that a significant number of recanalizations occurred in 3 (5.17%) of the patients, who subsequently received resection and successful closure. CONCLUSION: Percutaneous intervention of CPAF is feasible, but appropriate patients should be selected and experienced surgeons are required. After treatment of coronary artery fistula may appear recanalization, so these patients should be followed up radiography or other imaging studies.