摘要目的：探讨先天性冠状动脉瘘的治疗经验。方法回顾性分析2005年12月—2014年4月山东大学齐鲁医院收治的21例先天性冠状动脉瘘患者的临床资料,其中男12例、女9例,年龄2个月~74岁、平均27.8岁。21例患者均经心脏彩超或冠状动脉造影明确诊断。13例在体外循环下行经心腔或肺动脉冠状动脉瘘修补术,3例行介入封堵术,5例无症状、瘘口较小(1.5~3.5 mm)且不合并其他心脏畸形及并发症患者给予药物保守治疗。结果16例患者手术顺利,无围手术期死亡或心、脑并发症发生；术后1例合并卵圆孔未闭患者出现肺动脉高压危象,1例术后发现1.5 mm残余瘘,予相应处理后均痊愈出院。15例手术患者和5例保守治疗患者获0.7~9年(平均3.9年)随访。15例手术患者术后心脏彩超检查示冠状动脉瘘异常分流均消失,其中1例残余瘘患者瘘口闭合,1例患者冠状动脉近端出现迂曲瘤样改变；5例药物保守治疗患者中2例患者瘘口自然闭合,1例患者瘘口较前减小,2例患者瘘口无明显变化,均无相关并发症发生。结论手术治疗先天性冠状动脉瘘疗效确实可靠；对无症状、不合并其他需手术处理的心脏畸形、瘘口＜4 mm者,可采取保守治疗,部分患者可自然愈合。

abstractsObjective To investigate the experiences in the treatment of congenital coronary artery fistula(CAF).Methods The clinical data of 21 patients with CAF who were admitted to Qilu Hospital of Shandong University from December 2005 to April 2014 were retrospectively analyzed. There were 12 males, 9 females, their age ranged from 2 months to 74 years old, with a mean age of 27. 8 years. All patients performed echocardiography to confirm the fistula, or diagnosed by coronary angiography. Thirteen patients underwent surgical repair with cardiopulmonary bypass ( CPB) , 3 patients underwent transcatheter closure, and the other 5 patients were treated conservatively.Results No severe cerebral or cardiac complications were found during the perioperative period. The operation went smoothly in all 16 surgery patients, pulmonary hypertension crisis occurred in one case combined with patent ductus arteriosus, and 1.5 mm residual shunt was found in one patient. Fifteen patients of surgery and five patients with conservative treatment drugs were followed up for 0.7 to 9 years, average of 3.9 years. Fifteen surgery patients had no severe procedure-related complications, and no symptoms of the CAF during the follow-up period. Echocardiography confirmed that 15 patients underwent surgical and transcatheter closure abnormal shunts were disappeared. One patient, 1.5 mm residual fistula was healed, aneurysmal dilatation occurred in the proximal fistula in one patient. In 5 asymptomatic cases, no related complications occurred, 2 patients underwent spontaneous closure, the fistula diminished in 1 patient, no significant change was observed in two other cases.Conclusions The surgical and transcatheter closure of CAF is safe and efficient,it is possible that congenital coronary artery fistula can achieve spontaneous healing through conservative treatment once the fistula is no bigger than 4 mm, the patient is asymptomatic, no more other associated cardiac abnormalities are combined.