细小冠状动脉-支气管动脉瘘的影像特征与临床分析  

Imaging features of thirteen cases of coronary-to-bronchial artery micro-fistula and the related clinical analyses

作　　者：王珏[1] 徐磊[1] 

机构地区：[1]首都医科大学附属北京安贞医院医学影像科,100029

出　　处：《中华放射学杂志》2015年第8期586-589,共4页Chinese Journal of Radiology

摘　　要：目的探讨细小冠状动脉．支气管动脉瘘（CBF）的影像特征及临床特点。方法回顾性分析2007年5月至2011年11月进行冠状动脉造影检查的30284例无慢性肺部或肺血管疾病病史患者的影像资料，共检出13例细小CBV（瘘管近冠状动脉端直径〈2mm）。统计CBF的发生率、形态学特征，并对其相关临床状况进行初步分析与总结。采用独立样本t检验和χ2检验比较左右侧冠状动脉起源的CBF的直径和发生率。结果本组原发性细小CBF的检出率为0．043％（13／30284）。CBF近冠状动脉端均较纤细，直径平均值为（1．57±0．75）mm。CBF起自右冠状动脉6例（6支）及左冠状动脉回旋支7例（7支），未发现起自左冠状动脉前降支的患者。源自右冠状动脉及左冠状动脉回旋支的CBF发生率以及近冠状动脉端直径差异无统计学意义（χ2=0．400，t=0．107；P〉0．05）。13例CBF中9例的心肌缺血症状经造影证实为冠状动脉狭窄所致，4例无心肌缺血症状或症状极不典型者最终临床诊断为神经官能症，结合发出CBF后冠状动脉直径未见明显变化，提示被其分流的冠状动脉血流量较少，故而无明显血流动力学意义，不产生临床症状。结论先天性CBF可存在于无慢性肺或肺血管疾病的人群中。管径细小、均起自右冠状动脉及左冠状动脉回旋支是其最主要的影像特征。无其他各类冠状动脉瘘由于窃血所造成的心肌缺血症状，无明显血流动力学意义是其最根本的临床特征。Objective To investigate imaging features and clinical characteristics of the small coronary - bronchial artery fistula （CBF）. Methods By retrospective analysis of image data from May 2007 to November 2011 for coronary angiography in 30 284 patients without chronic lung or pulmonary vascular disease patients, 13 cases of small CBF （diameter of the end of fistula near coronary artery〈 2 mm） were detected. Incidence of CBF was counted, its morphology was described, and its clinical features were preliminarily analyzed and summarized. Independent sample t test and X2 test were used to compare diameters and incidences of CBF originatng from left and right coronary arteries. Results In this study primary CBF detection rate was 0.043%（13/30 284）. The ends of CBFs near coronary arteries were slender and their diameter average was （1.57 ± 0.75） mm. In this study all of the CBF were from the right coronary artery and left circumflex coronary artery, finding no cases starting from the left anterior descending coronary artery. There was no significant difference between incidence of CBFs originating from the right coronary artery and left circumflex coronary artery coronary and the diameters of CBFs. In 13 cases of CBF, 9 cases of myocardial ischemic symptoms were caused by coronary artery stenosis, which was proven by angiography; Four cases without myocardial ischemic symptoms or with very atypical symptoms were finally diagnosed as cardiac neurosis. After branching, the CBF diameters of these coronary arteries were seen no evindently reduced, which suggested that the coronary bypass had less blood flow, and therefore had no significant hemodynamic significance. Conclusions Congenital CBF can exist in populations without chronic lung or pulmonary vascular disease. The main image features are that their diametes were small and all originate from the right coronary artery and left circumflex coronary artery. The most fundamental clinical features are that there＇re no symptoms of myocardial ischemia due

关 键 词：动脉动脉瘘 冠状血管 支气管动脉 心血管造影术 

分 类 号：R816.2[医药卫生—放射医学]