摘要
目的探讨儿童先天性冠状动脉瘘介入治疗指征、方法学和并发症预防。方法19例先天性冠状动脉瘘患儿接受了经导管应用弹簧圈或Amplatzer动脉导管未闭(PDA)封堵器或Amplatzer无聚酯纤维栓子(Amplatzer plug)的介入治疗。其中1例为冠状动脉瘘术后残余漏合并PDA。结果19例冠状动脉瘘患儿瘘口最窄处平均直径(3．7±1．6)mm(2．5～8．2 mm)。右冠状动脉瘘11例,左冠状动脉前降支或回旋支瘘8例。与右心室交通14例,与右房交通5例。肺动脉平均压力为(28．0±5．0)mmHg(25．0～67．0 mmHg),肺动脉与体循环血流比值为1．6±0．8(1．0～2．3)。10例植入1枚Gianturco弹簧圈,3例植入2～4枚Gianturco弹簧圈,应用Duct-Occlud弹簧圈3例。另有2例应用Amplatzer PDA封堵器,应用Amplatzer plug 1例。1例冠状动脉瘘外科术后残余漏并合并PDA者,同时封堵PDA成功。即刻封堵率为55．6%(10/18),术后1个月及1年封堵率分别为88．9%(16/18),100%(18/18)；1例右冠状动脉右室瘘,在封堵后即刻发生弹簧圈漂移至左肺小动脉,用异物钳取出后再行外科手术。随访3个月～11年无再通和封堵器移位。结论介入治疗先天性冠状动脉瘘经济,安全、有效。
Objective To assess the safety and efficacy of transcatheter closure of congenital coronary artery fistulas（CAFs）. Methods Retrospective analysis was performed on 19 patients mean age of （5.5 ± 4.1 ） years treated from February 1995 to December 2005 with transcatheter closure of CAFs using transcatheter spring coil embolization, Amplatzer PDA occluder or Amplatzer plug. One case had a residul fistula postoperatively associated with patent ductus arteriosus （PDA）. Results The abnormal parameters included mean fistula diameter（3.7 ± 1.6）mm（2.5 - 8.2 mm）,pulmonary mean pressure（28.0 ± 5.0）mmHg（25.0 - 67.0 mmHg）and pulmonary to systemic shunt （Qp/Qs）1.6 ± 0.8 （1.0 - 2.3）. The sites of the fistulas were originated in right coronary artery 11, left anterior descending coronary artery or left circumflex coronary artery 8. Abnormal communication sites of these fistulas were to right ventricle in 14 and right atrium in 5. Various occlusion devices used to close these fistulas included one Gianturco coil in 10, 2 - 4 Gianturco coils in 3, Duct-Occlud in 3, Amplatzer duct occluder in 2 and Amplatzer plug in 1. The post-operative residul fistula with PDA was treated successfully with PDA occlusion. The immediate, one month and one year complete occlusion rates were 55.6%（10/18）, 88.9%（16/18）,100%（18/18）,respectively. The coil slipped into the left pulmonary artery in 1 case and correction was obtained by retrieving with forceps. Follow-up studies at 3 months to 4.3 years showed complete abolition of shunt in all patients with no evidence of recanalization leading to recurrences of shunt. Conclusion Transcatheter closure of CAFs is a safe and effective alternative to surgical repair.
出处
《介入放射学杂志》
CSCD
2006年第11期648-651,共4页
Journal of Interventional Radiology
关键词
冠状动脉瘘
介入治疗
封堵术
Coronary artery fistula
Interventional management
Occlusion
