经皮介入治疗105例冠状动脉瘘临床分析  

Clinical analysis of percutaneous intervention in 105 patients with coronary artery fistula

作　　者：张涵[1] 尹小龙[1] 张伟华[1] 光雪峰[1] 鲁一兵[1] 薛强[1] 戴海龙[1] ZHANG Han;YIN Xiao-long;ZHANG Wei-hua;GUANG Xue-feng;LU Yi-bing;XU Qiang;DAI Hai-long(Key Laboratory of Cardiovascular Disease of Yinnan Province,Clinical Medical Center for Cardiovascular Disease of Yunnan Province,Deparment of Cardiology,Yan'an Afiliated Hospital of Kurming Medical University,Kunming 650051,China)

机构地区：[1]昆明医科大学附属延安医院心血管内科云南省心血管疾病重点实验室云南省心脏疾病临床医学中心,云南省昆明市650051

出　　处：《中国心血管病研究》2020年第8期743-746,共4页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金(81360037、81700438);云南省卫生科研项目(2016NS312、2017NS333)。

摘　　要：目的评估经皮介入治疗冠状动脉瘘的临床疗效及安全性.方法回顾性分析2012年3月至2016年3月在昆明医科大学附属延安医院行经皮介入治疗105例冠状动脉瘘患者临床资料.结果男性65例,女性40例,共有冠状动脉瘘150支,单支63例(60.00%),两支40例(38.10%),三支2例(1.90%).右冠状动脉-肺动脉瘘63支(42.00%),前降支-肺动脉瘘70支(46.67%),前降支-左心房瘘10支(6.67%),回旋支-肺动脉瘘5支(3.33%),回旋支-左心房瘘1支(0.67%),右冠状动脉-右心室瘘1支(0.67%).冠状动脉瘘直径(8.59±5.18)mm,弹簧圈封堵103例,动脉导管未闭封堵器封堵1例、室间隔缺损封堵器封堵1例.术后冠状动脉造影无残余分流75例(71.43%),其中20例术后6个月复查冠状动脉造影未见残余分流;30例存在残余分流(28.57%),术后6个月复查冠状动脉造影,可见4例存在残余分流,其中2例外科手术治疗,2例定期随访,22例(包含2例定期随访患者,20例术后残余分流患者)术后12个月行冠状动脉造影未见明显分流.75例患者术后6个月超声心动图心脏腔室大小较前减小,左心房[(31.61±4.09)mm比(32.78±5.08)mm,P<0.05];左心室[(44.79±5.28)mm比(49.14±5.05)mm,P<0.05];右心室[(18.27±2.26)mm比(19.78±3.55)mm,P<0.05].结论经皮介入治疗冠状动脉瘘是一种有效的、安全的微创手术方法.Objective To evaluate the clinical fficacy and safety of percutancous intervention in the treatment of coronary artery fistula.Methods The clinical data of 105 patients who underwent percutaneous intervention close of coronary artery fistula in Yan'an Affiliated Hospital of Kunming Medical University from March 2012 to March 2016 were analyzed retrospectively.Results There were 150 coronary artery fistulas in 65 male and 40 female patients.one in 63 cases(60.00%).two in 40 cases(38.10%)and three in 2 cases(1.90%).There were 63 cases of right coronary artery-pulmonary artery fistula(42.00%),70 cases of left anterior descending-pulmonary artery fistula(46.67%).10 cases of left anterior descending-left atrial fistula(6.67%),5 cases of left circumflex-pulmonary artery fstua(3.33%),1 case of left circumflex-left atrial fistula(0.67%)and 1 case of right coronary artery-right ventricular fistula(0.67%).The diameter of coronary artery fistula was(8.59土5.18)mm.103 cases were occluded with coil,1 case with patent ductus arteriosus occluder and 1 case with ventricular septal defect occluder.There was no residual shunt in 75 cases(71.43%)after operation,among which 20 cases had no residual shunt in 6 months after operation and 30 cases with residual shunt(28.57%).4 patients had residual shunt in 6 months after operation including 2 patients were treated by surgery,2 patients were followed up regularly.There was no significant shunt(including 2 cases of regular follow-up and 20 cases of residual shunt after operation)in 22 patients with coronary angiography,12 months after operation.After 6 months of operation,the size of each chamber in the heart of 75 patients was smaller than that before operation with left atrium[(31.61+4.09)mm vs.(32.78±5.08)mm,P<0.05].left ventricle[(44.79±5.28)mm vs.(49.14±5.05)mm,P<0.05]and right ventricle[(18.27±2.26)mm vs.(19.78±3.55)mm,P<0.05].Conclusion Percutancous intervention closuse of coronary artery fistula is an ffective and safe minimally invasive method.

关 键 词：冠状动脉瘘 介入治疗 超声心动图 

分 类 号：R543.3[医药卫生—心血管疾病]