成人细小冠状动脉瘘介入封堵疗效评价及优化管理策略探讨  

Effect evaluation of transcatheter closure of small coronary artery fistula in adults and optimal management strategies explorement

作　　者：薛强[1] 光雪峰[1] 卢静[1] 张伟华[1] 鲁一兵[1] 杨栋[1] XUE Qiang;GUANG Xue-feng;LU Jing;ZHUANG Wei-hua;LU Yi-bing;YANG Dong(Department of Cardiology,The Affiliated Yan'an Hospital of Kunming Medical University,The Key Laboratory of Cardiovascular Diseases of Yunnan Province,Kunming 650051,China)

机构地区：[1]昆明医科大学附属延安医院心内科云南省心血管重点实验室

出　　处：《岭南心血管病杂志》2019年第4期410-415,共6页South China Journal of Cardiovascular Diseases

摘　　要：目的评价弹簧圈经皮封堵治疗成人细小冠状动脉瘘(small coronary artery fistula,sCAF)的安全性、有效性,并探讨此类患者的优化管理策略.方法研究纳入2003年9月至2017年12月在昆明医科大学附属延安医院接受弹簧圈封堵治疗的成人sCAF患者114例,并收集分析相关临床资料.结果114例成人sCAF患者接受封堵治疗,男68例(59.65%),女46例(40.35%),年龄(43.68±19.72)岁,102例封堵治疗成功.61例(53.51%)患者sCAF起源于左冠状动脉,36例(31.58%)起源于右冠状动脉,17例(14.91%)起源于双侧冠状动脉.肺动脉是sCAF最常见瘘入部位(88.60%),依次是右心室(3.51%),右心房、左心室(均为2.63%),左心房(1.75%),最后为冠状静脉窦(0.88%).左前降支-肺动脉瘘最常见(43.86%),其次是右冠状动脉-肺动脉瘘(27.19%).瘘道直径(3.02±0.77)mm,植入弹簧圈数量为(2.02±1.43)枚.术中出现急性心肌梗死2例,心动过缓1例,心脏骤停1例,窦道破裂1例.封堵术后即刻造影提示22例(21.57%)残余分流完全消失,69例(67.65%)血流明显减少,11例(10.78%)残存细小瘘而不能完全封堵.术后常规服用阿司匹林(100 mg/d)治疗3~6个月.术后随访1~62个月,10例患者再次出现胸闷或胸痛、心悸等症状,无出血、心肌梗死、栓塞、原发冠状动脉闭塞及瘘管破裂等并发症,既往潜在显微瘘管显影18例,复发5例,残余瘘11例,其中6例需要再次封堵治疗.结论使用弹簧圈封堵治疗sCAF是一种安全、有效的方法,疾病风险、干预风险、最大获益及最佳成本/效益比是优化管理策略的决策基础.Objectives To evaluate the safety and efficacy of percutaneous transcatheter closure by coils in the adult patients with small coronary artery fistula(sCAF)and explore optimal management strategies.Methods The 114 adult patients with sCAF were enrolled in our study,who accepted occlusion therapy using coils between September 2003 and December 2017 in The Affiliated Yan'an Hospital of Kunming Medical University.The clinical data of patients were collected and analyzed.Results There were 114 adult sCAF patients with mean age of(43.68±19.72)years who underwent interventional closure using coils,in which female and male were 46(40.35%),68(59.65%)respectively.There were 102 patients successfully closured by coils.There were 61 cases(53.51%),36 cases(31.58%)and 17 cases(14.91%)of the total sCAF patients respectively originated from left coronary artery,right coronary artery and bilateral coronary artery.The pulmonary artery was the most common site of the distal communication of sCAF(88.60%),in order followed by right ventricle(3.51%),right atrium and left ventricle(both identically 2.63%),left atrium(1.75%),the last coronary sinus(0.88%).Left anterior descending coronary artery-pulmonary artery fistula was the most common(43.86%),followed by right coronary artery-pulmonary artery fistula(27.19%).The mean diameter of fistula was(3.02±0.77)mm and the number of coils in each patient was 2.02±1.43.Intraoperative complications included 2 cases of acute myocardial infarction,1 case of bradycardia,1 case of cardiac arrest and 1 case of fistula canal rupture.Immediate coronary angiography after occlusion revealed complete disappearance of residual shunt in 22(21.57%)cases,significant reduction of the blood flow in 69(67.65%)cases,while 11(10.78%)cases could not be fully occluded on account of trivial to small residual fistula.The patients routinely accepted aspirin(100 mg/d)for 3 to 6 months after closure.In the followup term ranging from 1-62 months,symptoms such as chest pain or suppression and palpitation occurred again

关 键 词：冠状动脉瘘 成人 导管封堵 弹簧圈 管理 

分 类 号：R541.4[医药卫生—心血管疾病]