摘要目的总结52例先天性冠状动脉瘘的外科治疗效果. 方法 52例患者,年龄9个月-58岁,平均15.7±16.4岁.其中16例合并有其他心脏外科疾病.在36例单纯的先天性冠状动脉瘘患者中, 20岁以上者有9例,其术前均有临床症状.52例中右冠状动脉瘘占71.2%,左冠状动脉瘘占28.8%.瘘口终止于右室,右房,左室,左房及肺动脉分别为42.3%,30.8%,11.5%,5.8%和9.6%.结果手术全部在体外循环下进行,10例切开冠状动脉闭合瘘口,26例经心腔闭合瘘口,16例分别闭合瘘管在冠脉内的开口和在心腔内的开口.心腔内发现有两个瘘口者6例,三个瘘口者3例.余43例病人为单一瘘口,瘘口平均直径为7.34±4.12 ?mm (2-15?mm).全组无一例死亡及残余漏发生.40例随防1月到8年,平均3.14±1.84年,均无明显临床症状.一例有ST-T改变.结论早期手术是治疗先天性冠状动脉瘘安全和有效的方法.如合并有其他心脏外科疾病应同时矫治.准确判断瘘口的位置和确切可靠的缝合技术是防止残余漏的关键.

abstractsAbstract:Objective To evaluate the outcome of surgical treatment for congenital coronary artery fistulas (CAF) in 52 patients seen between May 1988 and July 1999.Methods Fifty-two patients ranging in age from 9 months to 58 years (mean 15.7±16.4 years) were studied. Thirty-six patients had no other cardiac defects, 9 of those patients were more than 20 years old and presented with symptoms. Only one of 36 patients less than 20 years old had clinical findings before surgery. Sixteen patients had associated cardiac lesions. The site of fistula origin was the right coronary artery in 37 patients (71.2%), and the left coronary artery in 15 patients (28.8%). The sites of CAF drainage were the right ventricle, right atrium, left ventricle, left atrium and pulmonary artery in 22 (42.3%), 16 (30.8%), 6 (11.5%), 3 (5.8%), and 5 (9.6%) patients, respectively. The mean diameter of the fistula in 43 patients with single ostium was 7.34±4.12?mm.Results Cardiopulmonary bypass was used in all patients and no patient died. An arteriotomy was made on the anomalous coronary artery and the proximal opening of a fistula was closed within the vessel in 10 patients. Closure of the distal opening of a fistula draining into a cardiac chamber or pulmonary artery was performed in 26 patients. In 16 patients, both the proximal and distal opening were closed. Two and 3 distal opening of a fistula were found in 6 and 3 patients, respectively. No residual shunt was found before patients were discharged from the hospital. Forty patients were followed up for a mean period of 3.14±1.84 years. The remaining 12 patients could not be contacted during follow-up. No clinical symptoms were found in those patients during follow-up but one patient still presented with ST-T change. Conclusion Early and properly surgical management is safe and effective for congenital coronary fistula.