CT冠状动脉造影在成人冠状动脉瘘诊断和分类方面的价值  

The value of CT coronary angiography in the diagnosis and classification of adult coronary artery fistulas

作　　者：范沙丽 刘鑫宇 张颖 罗震 刘晶哲 FAN Shali;LIU Xinyu;ZHANG Ying;LUO Zhen;LIU Jingzhe

机构地区：[1]清华大学第一附属医院放射科,北京市100016

出　　处：《中国研究型医院》2020年第4期23-27,共5页Chinese Research Hospitals

摘　　要：目的:评价CT冠状动脉造影(computed tomography coronary angiography,CTCA)在成人冠状动脉瘘(coronary artery fistulas,CAFs)诊断和分类方面的价值。方法:回顾性分析2015年10月~2020年4月在我院进行CTCA检查,诊断为CAFs的患者共36例,男25例、女11例,年龄33.0~83.0岁,中位年龄56.0岁,平均(57.4±11.3)岁。其中有症状者20例,胸痛8例、胸闷8例、胸痛伴胸闷1例、背疼2例、心悸1例。结果:冠状动脉瘘CTCA检查的影像表现:直接征象:①冠状动脉主干或分支迂曲扩张24例:局限性扩张5例,弥漫扩张19例;冠状动脉动脉瘤11例;②冠状动脉与心腔或其它血管交通的瘘口共38个,单个瘘管34例;另2例均是左右2支瘘管,1例瘘管分别开口于双侧动脉圆锥支、1例分别开口于前降支和右副冠状动脉;瘘管位置:肺动脉21个,左心房13个,右心房2个,左右心室各1个;瘘口的长径1~6mm。间接征象:引流心腔及大血管的改变:心腔扩大(左房扩大12例)、肺动脉高压(3例)。合并症:21例粥样硬化,6例冠脉肌桥,1例右冠状动脉起源异常,1例单冠畸形;1例心尖部室壁瘤,1例左心房多发憩室。根据冠状动脉瘘的起源进行分类,包括:①起源于左冠状动脉,共27个(27/38,71.1%)。其中前降支11例,窦房结支9例,回旋支5例,动脉圆锥支2例;②起源于右冠状动脉11个(11/38,28.9%)。其中右冠状动脉主干8例,动脉圆锥支2例,右副冠状动脉1例。结论:CTCA可以很好的显示CAFs的起止点、走行、分类以及周围心脏大血管的病变,对CAFs的临床诊断、治疗方案的制定以及术后评价起到重要的作用。Objective:To evaluate the role of CTCA is played in the diagnosis and classification of adult CAFs.Methods:We retrospectively analysis the patients diagnosed with CAFs in our hospital from October 2015 to April 2020.Total numbers of patients are 36,including 25 males and 11 females,aged 33-83 years old,median age 56 years old,mean age±standard deviation(57.4±11.3)years old.20 patients had symptoms,including chest pain of 8 patients,chest tightness of 8 patients,chest pain with chest tightness of 1 patient,back pain of 2 patients,and palpitation of 1 patient.Results:The imaging manifestations in CTCA examination of CAFs include:Direct signs:tortuous expansion of coronary artery trunk or branches of 24 cases:localized expansion of 5 cases,diffuse expansion of 5 cases.Coronary artery aneurysms of 11 cases.38 fistulas for coronary artery communication with the cardiac cavity or other vessels.Single fistula of 34 cases.The other two cases had two fistulas,one opened at bilateral conus branches,and the other opened at anterior descending branch and right accessory coronary artery.The fistula locations include:21 cases of pulmonary artery,13 cases of left atrium,2 cases of right atrium and 1 case of left and right ventricle.The size of the fistula is 1-6mm.Indirect signs:changes of drainage lumen and great vessels:12 cases of left atrial enlargement;Pulmonary hypertension(3 cases).Complications:21 cases of atherosclerosis,6 cases of coronary bridge,1 case of abnormal origin of right coronary artery,1 case of single coronary malformation;There was 1 case of apical ventricular aneurysm and 1 case of left atrial multiple diverticulum.Coronary fistula are classified according to the origin,Including:Originating from the left coronary artery in 27cases(27/38,71.1%):11 cases of anterior descending artery,9 cases of sinus node branch,5 cases of circumgyrate branch,and 2 cases of arterial conus branch.2.11 cases(11/38,28.9%)had right coronary artery origin:8 cases had right coronary artery trunk and 2 cases had conus branch.A

关 键 词：冠状血管 动脉动脉瘘 冠状血管造影术 体层摄影术 X线计算机 

分 类 号：R543.3[医药卫生—心血管疾病] R816.2[医药卫生—内科学]