Meyer J, Reul G J, Mullins C E, McCoy J, Hallman G L, Cooley D A
J Cardiovasc Surg (Torino). 1975 Sep-Oct;16(5):506-11.
Experience gained during the past 18 years at the Texas Heart Institute in the surgical treatment of 23 patients with coronary artery fistulae is reported. Patients ranged in age from three to 63 years; 18 were women. The right coronary artery was most frequently involved (14 patients) and in 18 patients the fistulous communication was terminal. Cardiac catheterization and angiography were aids in determining the exact diagnosis in all but two patients. During the last three years cardiopulmonary bypass was used in five of eight patients, and it is believed that extracorporeal circulation should be employed routinely. Terminal fistulae were ligated with sutures distally, close to the cardiac chamber. Lateral fistulae, when single, can be closed if feasible by tangential arteriorrhaphy. However, in most of these patients multiple communications and aneurysmal dilatation are encountered which would be treated more successfully by proximal and distal ligation of the fistula and distal coronary bypass revascularization. There were no operative deaths in our series. It is believed that with the help of today's advanced methods in anesthesia, extracorporeal circulation and coronary artery bypass surgery, all patients with coronary artery fistulae, once diagnosis has been made, should undergo surgical treatment.
本文报告了得克萨斯心脏研究所过去18年里对23例冠状动脉瘘患者进行外科治疗的经验。患者年龄从3岁到63岁不等；其中18例为女性。最常受累的是右冠状动脉（14例患者），18例患者的瘘管交通为终末型。除2例患者外，心脏导管检查和血管造影有助于明确诊断。在过去三年中，8例患者中有5例使用了体外循环，并且认为应常规采用体外循环。终末型瘘管在靠近心腔的远端用缝线结扎。单发的侧瘘如果可行，可通过切线动脉缝合术关闭。然而，在这些患者中，大多数会遇到多处交通和动脉瘤样扩张，对此通过瘘管的近端和远端结扎以及远端冠状动脉搭桥再血管化治疗会更成功。我们的系列病例中没有手术死亡。据信，借助当今先进的麻醉、体外循环和冠状动脉搭桥手术方法，所有冠状动脉瘘患者一旦确诊，都应接受手术治疗。
