Kilic Harun, Akdemir Ramazan, Bicer Asuman, Dogan Mehmet
Diskapi Yildirim Beyazit Training and Education Hospital, Cardiology Department, Ankara, Turkey.
Coron Artery Dis. 2008 Feb;19(1):43-5. doi: 10.1097/MCA.0b013e3282f19ad8.
We have described our experience with transcatheter occlusion of congenital coronary arterial fistulas in adults.
Six symptomatic patients, mean aged 41+/-12 years (four men, two women) underwent transcatheter occlusion of fistulas. All had chest pain or dyspnea on exertion. Four of the patients had single fistula. Two of the patients had multiple fistulas. The fistulas originated from the left anterior descending coronary artery in four patients, and from the circumflex artery in two. They all drained into the pulmonary trunk. Graft stenting was used in two patients who had multiple fistulas, and coils in four who had a single fistula. The coils were implanted through a microcatheter, which was passed through a JL 4 8F guiding catheter.
Coils were used to completely occlude fistulas. Two 3.0x20 mm coronary graft stents were deployed in the coronary arteries to occlude the fistulas. The procedures were uncomplicated. At follow up, all patients underwent coronary angiography, and one of the patients with coil embolization and one of the patients with graft stenting had small residual flow. Patient's chest pain or dyspneas have resolved after the procedure.
Transcatheter closure in adults of congenital coronary fistulas with graft stents and coils are safe and effective, and can be regarded as an acceptable alternative to surgery.
我们描述了成人先天性冠状动脉瘘经导管封堵的经验。
6例有症状患者，平均年龄41±12岁（4例男性，2例女性）接受了瘘管的经导管封堵。所有患者均有胸痛或劳力性呼吸困难。4例患者为单发瘘管。2例患者为多发瘘管。4例患者的瘘管起源于左前降支冠状动脉，2例起源于回旋支动脉。它们均引流至肺动脉干。2例多发瘘管患者使用了移植物支架，4例单发瘘管患者使用了弹簧圈。弹簧圈通过微导管植入，微导管经JL 4 8F引导导管送入。
使用弹簧圈完全封堵了瘘管。在冠状动脉中部署了2个3.0×20 mm冠状动脉移植物支架以封堵瘘管。手术过程无并发症。随访时，所有患者均接受了冠状动脉造影，1例接受弹簧圈栓塞的患者和1例接受移植物支架的患者有少量残余血流。术后患者的胸痛或呼吸困难已缓解。
成人先天性冠状动脉瘘使用移植物支架和弹簧圈进行经导管封堵是安全有效的，可被视为手术的一种可接受替代方法。
