先天性冠状动脉瘘早中期手术疗效分析  

Short and medium-term surgical treatment effects of congenital coronary artery fistula

作　　者：董柱 张本 曹一秋 刘莹 郑燕纯 杨博 马涛 张卫达 王晓武 DONG Zhu;ZHANG Ben;CAO Yiqiu;LIU Ying;ZHENG Yanchun;YANG Bo;MA Tao;ZHANG Weida;WANG Xiaowu(Department of Cardiovascular Surgery,Guangzhou General Hospital of Guangzhou Military Command,Guangzhou,510010,China;Graduate School,Southern Medical University)

机构地区：[1]中国人民解放军南部战区总医院心脏外科中心,广州510010 [2]南方医科大学

出　　处：《临床心血管病杂志》2020年第8期760-764,共5页Journal of Clinical Cardiology

基　　金：国家自然科学基金项目(No:81671885);广州市科技计划项目(No:201707010066);广州市珠江科技新星专项(No:201610010094);军委后勤保障部面上项目(No:18BJZ15)。

摘　　要：目的:探讨先天性冠状动脉瘘手术治疗的最佳时机、方法及疗效,努力提高手术成功率。方法:我院2013年10月-2019年10月共收治19例冠状动脉瘘患者,其中男11例,女8例,年龄4.5(1~61)岁,体重16.25(7~69)kg。右冠状动脉右房瘘3例,右冠状动脉右室瘘7例,右冠状动脉左室瘘1例,左冠状动脉右房瘘2例,左冠状动脉左房瘘2例,左冠状动脉右室瘘2例,左冠状动脉肺动脉瘘2例;合并先天性二尖瓣发育不良2例,房间隔缺损、室间隔缺损、卵圆孔未闭、三尖瓣关闭不全各1例。所有患者均胸正中切口体外循环下行动脉瘘矫治术,同期矫治其他心脏畸形,围术期常规监护治疗,术后1、6个月及每年随访复查。对所有患者临床资料进行统计、分析及总结。结果:升主动脉阻断时间(61.330±11.479)min,体外循环时间(99.940±15.206)min,手术时间(140.610±19.150)min,呼吸机使用时间(33.000±19.275)h,ICU时间(2.220±1.215)d,住院时间(20.940±8.795)d。患者术前左室射血分数(63.167±8.031)%,术后当日左室射血分数(69.390±8.389)%,术后左室功能明显改善(P<0.05)。患者术前心胸比0.506±0.0769,术后当日心胸比0.479±0.0603,手术前后心胸比差异显著(P<0.05)。19例患者围手术期无严重并发症及死亡,均痊愈出院。术后随访6个月~5年,未见残余瘘及严重心血管症状。结论:冠状动脉瘘发病率低,出现心悸、呼吸困难等症状应尽早手术治疗,外科手术治疗疗效较好,并发症少。Objective:To summarize clinical experiences and surgical outcomes of congenital coronary arterial fistula(CAF),and to provide evidence for surgical decision and postoperative recovery and improving the success rate of surgery.Method:We retrospectively analyzed clinical records of 19 patients who underwent surgical repair of CAF in our center from October 2013 to October 2019,including 11 males and 8 females.The median age was 4.5(1-61)years,and the median weight was 16.25(7-69)kg.There were 3 cases with right coronary artery-right atrial fistula,7 cases with right coronary artery-right ventricular fistula,1 case with right coronary artery-left ventricular fistula,2 cases with left coronary artery-right atrial fistula,2 cases with left coronary artery-left atrial fistula,2 cases with left coronary artery-right ventricular fistula,and 2 cases with anomalous left coronary artery from the pulmonary artery.Two patients complicated with congenital mitral valve dysplasia,1 case complicated with atrial septal defect,1 case complicated with ventricular septal defect,1 case complicated with patent foramen ovale,and 1 case complicated with tricuspid insufficiency.All patients underwent CAF correction under cardiopulmonary bypass through thoracic median incision,and other cardiac malformations were corrected at the same time.Routine monitoring and treatment were performed in the perioperative period,1 month,6 months,and annual follow-up after operation were conducted.The clinical data of all patients were statistically analyzed and summarized.Result:The aortic cross-clamping time was(61.33±11.479)min,the cardiopulmonary bypass time was(99.94±15.206)min,the operation time was(140.61±19.150)min,the intubation duration was(33±19.275)h,the length of ICU stay was(2.22±1.215)d,and the length of hospital stay was(20.94±8.795)d.The preoperative left ventricular ejection fraction(LVEF)was(63.167±8.031)%,the postoperative LVEF was(69.39±8.389)%,and the postoperative left ventricular function were significantly improved(P<0.05)

关 键 词：先天性冠状动脉瘘 外科治疗 预后 

分 类 号：R541.1[医药卫生—心血管疾病]