Department of Cardiovascular Surgery, Tokyo Women's Medical University, Japan.
Tohoku J Exp Med. 2011 Mar;223(3):205-9. doi: 10.1620/tjem.223.205.
Congenital coronary artery fistula (CAF) is a rare anomaly involving communication between the coronary artery and any cardiac chamber. We retrospectively studied 23 patients with CAF who were surgically treated at 2 institutes over the past 38 years. All patients had continuous murmur and were diagnosed using echocardiography and cardiac catheterization. Eighteen patients had no other heart anomalies, and 5 had an associated anomaly. Fifteen patients were treated using cardiopulmonary bypass via differential surgical approaches (6 patients, CAF orifice closure through cardiac chamber; 6, coronary arteriotomy for CAF orifice closure; and 3, CAF ligation). Eight patients underwent CAF ligation without cardiopulmonary bypass. CAF originated from the right coronary artery in 11 patients; the left coronary artery in 10, and both arteries in 2. Drainage occurred at the following sites: the right ventricle (10 patients), right atrium (6), left ventricle (4), left atrium (2), and pulmonary artery (1). All surgeries were performed through a median sternotomy. There were no mortalities during or after the hospital stay. Aortic root replacement was performed in 1 patient 30 years after the CAF surgery. Three of the 6 patients who underwent coronary arteriotomy for CAF orifice closure showed coronary artery occlusion at the distal coronary arteriotomy site with long-term collateral formation. Surgical management of CAF was thus effective, resulting in 100% long-term survival and closure rates. Dilated CAF-associated vessels have been normalized for the long term. CAF should be therefore considered even in asymptomatic patients because of the risk of future complications.
先天性冠状动脉瘘（CAF）是一种罕见的异常情况，涉及冠状动脉与任何心腔之间的沟通。我们回顾性研究了过去 38 年在 2 个机构接受手术治疗的 23 例 CAF 患者。所有患者均有连续性杂音，并通过超声心动图和心导管检查进行诊断。18 例患者无其他心脏异常，5 例患者存在相关异常。15 例患者采用心肺转流术通过不同的手术方法进行治疗（6 例患者通过心腔闭合冠状动脉瘘口；6 例患者通过冠状动脉切开术闭合冠状动脉瘘口；3 例患者通过结扎冠状动脉瘘口）。8 例患者在无体外循环的情况下进行了冠状动脉瘘结扎术。冠状动脉瘘口起源于右冠状动脉 11 例；左冠状动脉 10 例，左右冠状动脉各 2 例。引流部位如下：右心室（10 例）、右心房（6 例）、左心室（4 例）、左心房（2 例）和肺动脉（1 例）。所有手术均通过正中胸骨切开术进行。在住院期间或之后，没有死亡病例。1 例患者在冠状动脉瘘手术后 30 年时进行了主动脉根部置换术。6 例接受冠状动脉切开术闭合冠状动脉瘘口的患者中，有 3 例出现远端冠状动脉切开处的冠状动脉闭塞，长期形成侧支循环。因此，CAF 的手术治疗是有效的，长期存活率和闭合率达到 100%。长期来看，扩张的 CAF 相关血管已经恢复正常。因此，即使无症状患者也应考虑 CAF，因为存在未来并发症的风险。
