Reith Sebastian, Reinartz Sebastian D, Burgmaier Mathias, Marx Nikolaus, Mahnken Andreas H
Department of Cardiology/Medical Clinic I, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, Aachen, Germany.
Coron Artery Dis. 2013 Aug;24(5):422-30. doi: 10.1097/MCA.0b013e328362225a.
Transcatheter coil embolization of coronary artery fistulas (CAFs) has emerged as an alternative to surgical closure despite limited data in the current literature. The aim of this study was to show the efficacy of CAF closure and the benefit of the combined preinterventional use of cardiac computed tomography and coronary angiography to evaluate the feasibility and enhance the safety of this procedure by obtaining precise information about the CAF anatomy.
Five consecutive patients (three men, two women, age 51-68 years) with symptomatic angiographically proven CAFs were screened for transcatheter treatment and underwent preinterventional cardiac multidetector computed tomography (MDCT).
On the basis of CAF-associated clinical symptoms, exercise-induced ischemia, coronary angiography, and cardiac MDCT, four of five patients with a CAF draining into the pulmonary artery system were considered eligible for transcatheter coil embolization, whereas in MDCT the fifth patient had multiple draining sites of the CAF and a relevant drainage into the right ventricular myocardium and was thus excluded from the procedure. Coil embolization was successfully performed in the remaining four cases without any complications. There was no residual flow through the CAF after the procedure. Clinical symptoms resolved almost completely in all four patients during a median 15.6-month follow-up.
Transcatheter coil embolization is a feasible and effective method for the treatment of symptomatic CAFs in selected cases. The adjunctive preinterventional use of cardiac MDCT with conventional angiography can identify vessels that are anatomically applicable for transcatheter closure, defer therapy in morphologically unsuitable complex cases, and thus optimize the safety of the procedure.
尽管目前文献中的数据有限，但经导管弹簧圈栓塞冠状动脉瘘（CAF）已成为手术闭合的一种替代方法。本研究的目的是展示CAF闭合的疗效以及在介入治疗前联合使用心脏计算机断层扫描和冠状动脉造影的益处，通过获取有关CAF解剖结构的精确信息来评估该手术的可行性并提高其安全性。
连续筛选出5例经血管造影证实有症状的CAF患者（3例男性，2例女性，年龄51 - 68岁）进行经导管治疗，并在介入治疗前接受心脏多排计算机断层扫描（MDCT）。
根据与CAF相关的临床症状、运动诱发的缺血、冠状动脉造影和心脏MDCT，5例CAF引流至肺动脉系统的患者中有4例被认为适合经导管弹簧圈栓塞，而在MDCT检查中，第5例患者的CAF有多个引流部位且有大量血液引流至右心室心肌，因此被排除在该手术之外。其余4例成功进行了弹簧圈栓塞，无任何并发症。术后CAF无残余血流。在中位15.6个月的随访期间，所有4例患者的临床症状几乎完全缓解。
经导管弹簧圈栓塞是治疗部分有症状CAF的一种可行且有效的方法。在介入治疗前将心脏MDCT与传统血管造影联合使用，可以识别在解剖结构上适合经导管闭合的血管，在形态学上不适合的复杂病例中推迟治疗，从而优化手术的安全性。
