Velvis H, Schmidt K G, Silverman N H, Turley K
Department of Pediatrics, University of California, San Francisco.
J Am Coll Cardiol. 1989 Oct;14(4):968-76. doi: 10.1016/0735-1097(89)90474-9.
Ten consecutive patients with a coronary artery fistula, aged 1 day to 4 years, were studied by two-dimensional echocardiography, pulsed Doppler ultrasound and color flow imaging. All patients underwent cardiac catheterization, and seven patients had surgical closure of the fistula. The origin, course and site of drainage of the coronary artery fistula were correctly identified prospectively by echocardiographic examination in all patients. Color flow imaging was particularly helpful in visualizing the site of drainage of the fistula. Diameters of the right and left coronary arteries at their origin and of the aortic root were measured from two-dimensional echocardiographic frames and compared with measurements obtained in normal children. The ratio of coronary artery diameter to aortic root diameter in normal children was 0.14 +/- 0.03 (mean +/- SD) for the right coronary artery and 0.17 +/- 0.03 for the left coronary artery. These normal ratios were greatly exceeded for coronary arteries feeding the fistula, and ranged from 0.68 to 0.84 for the right coronary artery and from 0.34 to 0.52 for the left coronary artery. All anatomic information needed for surgical treatment of coronary artery fistula was consistently obtained by echocardiography with color flow imaging. The fistula was closed from within the heart in five patients and by ligation from the epicardial surface in two patients. In these latter patients, intraoperative color flow imaging at the time of ligation proved to be extremely valuable in achieving complete closure.
对10例年龄从1天至4岁的冠状动脉瘘患者进行了连续研究，采用二维超声心动图、脉冲多普勒超声和彩色血流成像技术。所有患者均接受了心导管检查，7例患者进行了瘘管的手术闭合。通过超声心动图检查前瞻性地正确识别了所有患者冠状动脉瘘的起源、走行和引流部位。彩色血流成像在显示瘘管引流部位方面特别有帮助。从二维超声心动图图像测量了左右冠状动脉起始处及主动脉根部的直径，并与正常儿童的测量值进行比较。正常儿童右冠状动脉直径与主动脉根部直径之比为0.14±0.03（均值±标准差），左冠状动脉为0.17±0.03。向瘘管供血的冠状动脉大大超过了这些正常比例，右冠状动脉范围为0.68至0.84，左冠状动脉为0.34至0.52。通过彩色血流成像的超声心动图始终能够获得冠状动脉瘘手术治疗所需的所有解剖学信息。5例患者经心内闭合瘘管，2例患者经心外膜表面结扎。在这些后一组患者中，结扎时的术中彩色血流成像在实现完全闭合方面被证明极具价值。
