Department of Cardiovascular Surgery, Fu Wai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiovascular Surgery, Fu Wai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ann Thorac Surg. 2014 Feb;97(2):530-6. doi: 10.1016/j.athoracsur.2013.09.015. Epub 2013 Nov 6.
Left circumflex coronary artery (LCX) fistula is rare, and surgical experience is limited. We report our experience with 29 patients with LCX fistula during a 25-year period in terms of clinical features, pathology, surgical procedure, and late outcomes.
Between June 1988 and July 2013, 29 patients (19 males, 10 females; median age, 10 years) with LCX fistula were treated surgically and followed up. Preoperative diagnosis was made echocardiographically in 29 patients and angiographically in 17. The fistula drained into the right atrium in 12, the right ventricle in 8, left atrium and left ventricle, each in 3, main pulmonary artery in 2, and coronary sinus in 1. Surgical procedure included endocardial closure in 17 patients, epicardial closure in 5, endocardial and epicardial closure in 2, suture ligation in 1, and off-pump suture ligation in 4. Postoperative anticoagulation was prescribed for at least 6 months.
There were no operative deaths. Complications included residual shunt in 2 patients, and LCX thrombosis, pneumothorax, hemoglobinuria, and wound infection, each in 1 patient. At the latest follow-up extending to 25 years (mean, 10.1±4.6 years), 17 patients were asymptomatic and in New York Heart Association functional class I, 4 in II and 2 in III. Residual shunt, myocardial infarction, and right atrial thrombosis occurred, each in 1 patient.
Surgical repair of LCX fistula is safe and effective, with low risks and favorable late outcomes. Our experience implies the necessity for postoperative anticoagulation therapy to achieve good long-term outcomes.
左回旋支冠状动脉（LCX）瘘管较为罕见，手术经验有限。我们报告了在 25 年期间对 29 例 LCX 瘘管患者的经验，包括临床特征、病理学、手术过程和晚期结果。
1988 年 6 月至 2013 年 7 月期间，29 例（19 例男性，10 例女性；中位年龄 10 岁）LCX 瘘患者接受了手术治疗并进行了随访。29 例患者术前通过超声心动图诊断，17 例通过血管造影诊断。瘘管引流至右心房 12 例，右心室 8 例，左心房和左心室各 3 例，主肺动脉 2 例，冠状窦 1 例。手术方法包括 17 例心内膜闭合术、5 例心外膜闭合术、2 例心内膜和心外膜闭合术、1 例缝线结扎术和 4 例体外循环缝线结扎术。术后至少抗凝 6 个月。
无手术死亡。并发症包括 2 例残余分流，1 例 LCX 血栓形成、气胸、血红蛋白尿和伤口感染。在最长达 25 年（平均 10.1±4.6 年）的最新随访中，17 例患者无症状，纽约心脏协会功能分级为 I 级，4 例为 II 级，2 例为 III 级。残余分流、心肌梗死和右心房血栓各 1 例。
LCX 瘘管的手术修复是安全有效的，风险低，晚期结果良好。我们的经验表明，术后抗凝治疗是获得良好长期结果的必要条件。
