Cheung D L, Au W K, Cheung H H, Chiu C S, Lee W T
Department of Surgery, The University of Hong Kong, Grantham Hospital, Aberdeen.
Ann Thorac Surg. 2001 Jan;71(1):190-5. doi: 10.1016/s0003-4975(00)01862-2.
Opinions vary as to whether operation should be offered patients with coronary artery fistula, particularly to those who are asymptomatic. Published studies lacked long-term follow-up data.
We studied 41 patients with coronary artery fistula operated in our unit in the past 30 years with restudies including coronary angiograms in those who agreed to the investigation.
There was no operative mortality and operative morbidity was low. The mean duration of follow-up was 9.1 years and 96.9% of the patients were asymptomatic. Twenty-one patients had a coronary angiogram. The native coronary artery either remained dilated and tortuous, or more frequently had thromboses with a short proximal stump. (None of these patients had evidence of myocardial ischemia.) Four patients had demonstrable recurrence fistula but without hemodynamic disturbance.
We advocate operation for all patients with coronary artery fistulas and demonstrable shunting in view of minimal operative risks. Small asymptomatic fistulas without demonstrable shunting should be left alone. The relatively high incidence of residual or recurrent fistula makes long-term follow-up mandatory.
对于是否应为冠状动脉瘘患者（尤其是无症状患者）实施手术，存在不同观点。已发表的研究缺乏长期随访数据。
我们研究了过去30年在我院接受手术的41例冠状动脉瘘患者，并对同意接受检查的患者进行复查，包括冠状动脉造影。
无手术死亡病例，手术并发症发生率低。平均随访时间为9.1年，96.9%的患者无症状。21例患者进行了冠状动脉造影。原生冠状动脉要么仍扩张迂曲，要么更常见的是近端残端短且有血栓形成。（这些患者均无心肌缺血证据。）4例患者有可证实的复发性瘘，但无血流动力学紊乱。
鉴于手术风险极小，我们主张对所有有冠状动脉瘘且有明显分流的患者进行手术。无明显分流的小无症状瘘应不予处理。残余或复发性瘘的发生率相对较高，因此必须进行长期随访。
