Chiu Shuenn-Nan, Wu Mei-Hwan, Lin Ming-Tai, Wu En-Ting, Wang Jou-Kou, Lue Hung-chi
Department of Pediatrics, National Taiwan University Hospital, School of Medicine, National Taiwan University, 7 Chung-Shan S. Rd, Taipei 100, Taiwan.
Int J Cardiol. 2005 Aug 18;103(2):187-92. doi: 10.1016/j.ijcard.2004.09.005.
Most coronary artery fistulas were reported as congenital. Acquired coronary artery fistula occurring after cardiac surgery has rarely been reported.
From 1998 to 2003, 10 patients with coronary artery fistula detected by echocardiography after open heart surgery for congenital heart disease were included. Their ages ranged from 2 months to 41 years (median 4.2 years). The underlying heart disease was tetralogy of Fallot in five patients, ventricular septal defect in three, double chamber right ventricle in one, and transposition of the great arteries with ventricular septal defect in the remaining one.
Of these 10 patients, the coronary artery fistula originated from the left coronary artery in four, right coronary artery in two, and unknown origin in the remaining four. The coronary artery fistula drained into the right ventricle in nine and into the left ventricle in the remaining one. The incidence of acquired coronary artery fistula after open heart surgery for congenital heart disease was 0.44% (8/1832). The identified risk factors for acquired coronary artery fistula were reoperation and right ventricular muscle resection in ventricular septal defect. After follow-up for 0.5-12 years (mean 4.1+/-3.3 years), the coronary artery fistula persisted, but neither symptoms nor significant left-to-right shunt was noted.
Acquired coronary artery fistula is a rare complication after cardiac surgery. Reoperation and resection of right ventricular hypertrophic muscle increase the risk of this complication. Although shunt flow did not increase during follow-up, the significance of acquired coronary artery fistula needs further investigation.
大多数冠状动脉瘘被报道为先天性的。心脏手术后发生的后天性冠状动脉瘘鲜有报道。
纳入1998年至2003年间，10例先天性心脏病心脏直视手术后经超声心动图检测出冠状动脉瘘的患者。他们的年龄从2个月至41岁不等（中位年龄4.2岁）。潜在的心脏病包括5例法洛四联症、3例室间隔缺损、1例右心室双腔心，其余1例为大动脉转位合并室间隔缺损。
在这10例患者中，冠状动脉瘘起源于左冠状动脉4例，右冠状动脉2例，其余4例起源不明。冠状动脉瘘9例引流至右心室，其余1例引流至左心室。先天性心脏病心脏直视手术后后天性冠状动脉瘘的发生率为0.44%（8/1832）。后天性冠状动脉瘘已确定的危险因素是再次手术和室间隔缺损时右心室肌肉切除。随访0.5至12年（平均4.1±3.3年）后，冠状动脉瘘持续存在，但未发现症状或明显的左向右分流。
后天性冠状动脉瘘是心脏手术后一种罕见的并发症。再次手术和切除右心室肥厚肌肉会增加这种并发症的风险。尽管随访期间分流流量未增加，但后天性冠状动脉瘘的意义需要进一步研究。
