冠状动脉畸形15例临床分析  

Clinical analysis of fifteen patients with coronary artery anomaly

作　　者：刘日辉[1] 罗毅[2] 张健群[2] 尤斌[2] 王盛宇[2] 张红[2] 韩杰[2] 

机构地区：[1]华中科技大学同济医学院附属襄樊医院心胸外科,湖北襄樊441021 [2]首都医科大学附属北京安贞医院心外科

出　　处：《中国医师进修杂志（外科版）》2008年第11期5-7,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的总结先天性冠状动脉畸形的外科治疗经验。方法15例冠状动脉畸形患者中冠状动脉瘘11例，冠状动脉起源异常4例。合并风湿性心瓣膜病1例，法洛四联症1例。非体外循环下手术6例，其中5例行孤立瘘支动脉结扎术，1例行冠状动脉切线缝扎术；体外循环下经心腔修补内瘘口手术4例；体外循环心脏停跳下切开冠状动脉修补外瘘口1例；左冠状动脉回旋支异常起源于左肺动脉行回旋支左肺动脉开口处结扎术1例，左锁骨下动脉与左冠状动脉吻合、肺动脉端开口处结扎术1例，左冠状动脉主干移植术2例，合并的心脏疾病均同时纠治。结果1例因术后低心排血量综合征死亡，余14例术后心悸、胸闷、心脏杂音消失，均痊愈出院。结论冠状动脉畸形一旦确诊，应及时采用适宜的矫治技术治疗。Objective To summarize the clinical experience of surgical treatment for the congenital coronary artery anomaly. Methods 15 patients with coronary artery anomaly, congenital coronary artery fistulas were 11 patients, including 1 patient associated with Fallot, 5 patients underwent ligation of isolated fistula and 1 patient＇s fistula was performed tangent suture through off-pump cardiopulmonary bypass, 4 patients＇ fistulas were repaired by endocardiac way and 1 patient was mended through dissection of fistula under on-pump cardiopulmonary bypass. Anomalous origin of the left coronary artery from pulmonary artery were 4 patients and 1 patient associated with rheumatoid valve disease. Operative methods included ligation of left circumflex （1 case ）, anastomosis of left subclavian artery-left main （ 1 case ） and transplantation of left main （ 2 cases ）. Results There was 1 death because of severe low cardiac output syndrome, and there was good prognosis and no clinical symptoms found in 14 patients during follow-up. Conclusion The feasible operation for the coronary artery anomaly should be performed as early as possible once diagnosed correctly.

关 键 词：冠状血管畸形 胸廓内动脉-冠状动脉吻合术 心脏外科手术 

分 类 号：R541.1[医药卫生—心血管疾病] R543.5[医药卫生—内科学]