电解脱弹簧圈封堵先天性冠状动脉-肺动脉瘘30例临床疗效分析  

Occlusion of congenital coronary artery-pulmonary artery fistula with electro-detachable spring coil:analysis of clinical curative effect in 30 patients

作　　者：高见书 张国兵[2] 周国伟[2] 赵军礼[2] 黄为 汪芳[2] GAO Jianshu, ZHA NG Guobing, ZHOU Guowei, ZHAO Junli, HUANG Wei, WANG Fang.(Department of Cardiology, Yaneheng Municipal First People Is Hospital, Yancheng, Jiangsu Province 224005, Chin)

机构地区：[1]江苏盐城市第一人民医院心内科,224005 [2]上海交通大学附属第一人民医院心内科

出　　处：《介入放射学杂志》2018年第5期400-403,共4页Journal of Interventional Radiology

基　　金：上海市科委课题项目(16140901400)

摘　　要：目的探讨电解脱弹簧圈封堵治疗先天性冠状动脉-肺动脉瘘的效果及经验。方法回顾性分析2008年1月至2017年8月收治的30例成人先天性冠状动脉-肺动脉瘘患者临床资料。评价电解脱弹簧圈封堵技术治疗的可行性、安全性和有效性。结果 30例患者中29例封堵成功,瘘管平均直径(2.17±0.07)mm,平均植入弹簧圈(2.31±0.17)枚;1例因术中突发急性心力衰竭终止手术。29例中1例予1枚弹簧圈未能完全封堵靶血管,加用1枚弹簧圈后封堵成功;1例因血管迂曲导丝不能到位,1个月后再手术时更换指引导管和微导管,即刻封堵成功。16例有胸闷、胸痛临床表现患者症状均缓解。术后1、3、6个月随访未见介入相关并发症。术后6个月27例瘘管完全封堵,未完全封堵、复发各1例,遂再行弹簧圈封堵成功。结论经导管电解脱弹簧圈封堵治疗冠状动脉瘘-肺动脉瘘微创、安全有效,但远期疗效仍需随访观察。Objective To assess the clinical curative effect of occlusion of congenital coronary artery-pulmonary artery fistula（CAPAF） with electro-detachable spring coil, and to summary the initial experience.Methods The clinical data of 30 adult patients with CAPAF, who were admitted to authors＇ hospital during the period from January 2008 to August 2017 to receive treatment, were retrospectively analyzed. The clinical feasibility, safety and effectiveness of using electro-detachable spring coil to treat CAPAF were evaluated.Results Of the 30 patients, successful occlusion of CAPAF was achieved in 29. The mean diameter of fistula was（2.17±0.07） mm, the average number of implanted coils for one patient was（2.31±0.17） coils. In one patient, the occlusion procedure had to be stopped as the patient suddenly developed acute heart failure during the operation. Among the 29 patients who had successful occlusion of CAPAF, in one patient one spring coil could not completely occlude the target vessel, and additional one spring coil had to be used to totally obstruct CAPAF; in another patient the guide wire could not be inserted to right place as the vessels were very tortuous, and one month later operation had to be carried out again by using suitable guiding catheter and micro-catheter, and instant successful occlusion of CAPAF was obtained. After the operation,the clinical symptoms in 16 patients, who had chest tightness and chest pain, were all relieved. The patients were followed up at one, 3 and 6 months after the operation, and no intervention-related complications occurred. At six months after operation, complete closure of CAPAF was observed in 27 patients, incomplete occlusion in one patient and recurrence in one patient, then, the occlusion with use of coil had to be carried out again. Conclusion For the treatment of CAPAF, transcatheter closure with electro-detachable spring coil is safe and effective, although its long-term effect still needs to be clarified with follow-up observation.

关 键 词：电解脱弹簧圈 先天性冠状动脉-肺动脉瘘 介入治疗 

分 类 号：R528.1[医药卫生—内科学]