Interlock可解脱弹簧圈系统在冠状动脉-肺动脉瘘栓塞术中的应用  

Application of interlock detachable coils system for occlusion of coronary-pulmonary fistula

作　　者：万俊义 张戈军[1] 徐仲英[1] 胡海波[1] 蒋世良[1] 徐亮 WAN Jun-yi;ZHANG Ge-jun;XU Zhong-ying;HU Hai-bo;JIANG Shi-liang;XU Liang.(Department of Structural HeartDisease Center,Cardiovascular Institute and Fuwai Hospital,Chinese Academy of Medical Sciences and PekingUnion Medical College,Beijing l00037,China)

机构地区：[1]国家心血管病中心中国医学科学院阜外医院结构性心脏病中心,北京100037

出　　处：《中国介入心脏病学杂志》2018年第12期696-699,共4页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨Interlock可解脱弹簧圈系统应用于冠状动脉-肺动脉瘘栓塞术的安全性及有效性。方法回顾性分析2016年12月23日至2017年9月7日于中国医学科学院阜外医院选用Interlock可解脱弹簧圈系统行冠状动脉-肺动脉瘘栓塞术的6例冠状动脉-肺动脉瘘患者临床资料,其中包括男性2例,女性4例。所有患者均常规采用右侧桡动脉入径行冠状动脉造影以明确诊断,沿导管置入并释放Interlock可解脱弹簧圈于瘘管或瘤腔内,栓塞后行选择性冠状动脉造影评价疗效,观察术中及术后有无并发症发生。结果 6例选用Interlock可解脱弹簧圈行冠状动脉-肺动脉瘘栓塞术的患者均手术成功,无血管损伤及心肌梗死等术中并发症发生。有4例合并动脉瘤形成,其中3例应用弹簧圈填塞在动脉瘤体,1例栓塞在动脉瘤近心端瘘管。术中共用Interlock可解脱弹簧圈18枚,其中3枚为钻石型,15枚为普通2D型;弹簧圈直径为2～12 mm,长度为2.3～30 cm;瘘口直径为2～3 mm。即刻行选择性冠状动脉造影,其中3例为完全栓塞,3例有少量残余分流。术后所有患者胸闷、胸痛症状均得以缓解;超声心动图提示无异常血流,X线胸片提示弹簧圈位置、形态良好,心电图检查无新发心律失常或心肌缺血等改变。随访12个月,无心肌梗死、心源性休克、心室颤动、心室扑动、心脏破裂或猝死等主要不良心血管事件发生。结论 Interlock可解脱弹簧圈系统可控性高、安全性好,尤其适用于伴有动脉瘤形成、血管迂曲需要准确定位的冠状动脉-肺动脉瘘患者介入治疗。Objective To investigate the feasibility and efficacy of interlock fibered detachable coils(IDC)for occlusion of coronary-pulmonary fistula.Methods Six patients,2males and4female with coronary-pulmonary fi stula were treated with IDC from Dec2016to Sep2017.The age of the patients ranged from50to67years old(average62years old),and their weight ranged between55~91kg(average68kg).Results Successful embolism was achieved in all6coronary-pulmonary fi stula patients.There were4cases combined with aneurysm formation and among them,3cases had aneurysm stuff ed with IDC and1case was embolized in proximal fi stula.A total of18coils were deployed in6patients,of which3diamonds and15regular2D.The sizes of IDC used included diameter2~12mm and length2.3~30cm.The size of fi stula orifi ces was2~3mm.Three cases had complete embolization and the other3cases had mild residual shunt after embolization.After operation,the symptoms of chest congestion and chest pain were relieved.No major adverse cardiovascular events such as myocardial infarction,cardiac shock,ventricular fi brillation or fl utter,heart rupture or sudden death occurred.Conclusions Interlock fi bered detachable coils has high controllability and safety.Transcatheter coil embolization can be performed safely and eff ectively in coronary-pulmonary fi stula,especially with aneurysm formation and tortuous arteries.

关 键 词：冠状动脉瘘 Interlock可解脱弹簧圈 介入栓塞术治疗 

分 类 号：R541.1[医药卫生—心血管疾病]