Tiritilli A, Iaria P, Viard P, Sayah S, Benali T, Detienne J-P, Martis S, Tchatchum F, Aouate P
Service de cardiologie, centre hospitalier Laennec, 60100 Creil, France.
Service de cardiologie, centre hospitalier Laennec, 60100 Creil, France.
Ann Cardiol Angeiol (Paris). 2016 Feb;65(1):31-7. doi: 10.1016/j.ancard.2013.04.006. Epub 2013 Apr 20.
The coronary fistula is a link between one or more of the coronary arteries and cardiac cavity or great vessel. The exact occurrence is unknown. The majority of these fistulas are congenital in origin. However, they may occasionally be detected after cardiac surgery. For a long time, fistulas are asymptomatic, especially if they are small; the frequency of the symptoms and especially the complications rise with age. The potential complications are: cardiac failure, endocarditis, endarteritis, atrial fibrillation, ventricular arrhythmias, rupture, and thrombosis. The main differential diagnosis is patent arterial duct, while other congenital arteriovenous shunts need to be excluded. Even though echocardiography Doppler can help to differentiate shunts, the coronary angiography remains the main diagnostic tool for the description of the anatomy. For a long time, the surgery was the only therapeutic means, up till now, percutaneous occlusion is the first line therapy of coronary fistulas and that the different devices can be tailored to meet different anatomic and functional characteristics.
冠状动脉瘘是一条或多条冠状动脉与心腔或大血管之间的连接通道。确切的发病率尚不清楚。这些瘘管大多起源于先天性。然而，它们偶尔也可能在心脏手术后被发现。长期以来，瘘管通常无症状，尤其是瘘管较小时；症状尤其是并发症的发生率会随着年龄增长而升高。潜在的并发症包括：心力衰竭、心内膜炎、动脉内膜炎、心房颤动、室性心律失常、破裂和血栓形成。主要的鉴别诊断是动脉导管未闭，同时需要排除其他先天性动静脉分流。尽管超声心动图多普勒有助于鉴别分流，但冠状动脉造影仍是描述解剖结构的主要诊断工具。长期以来，手术是唯一的治疗手段，直到现在，经皮封堵术是冠状动脉瘘的一线治疗方法，不同的器械可根据不同的解剖和功能特点进行定制。
