儿童和成人冠状动脉瘘畸形的临床特征：24年经验总结

The clinical characteristics of coronary artery fistula anomalies in children and adults: A 24-year experience.

作者信息

Huynh Kieu T, Truong Vien T, Ngo Tam N M, Dang Thao B, Mazur Wojciech, Chung Eugene S, Tretter Justin T, Kereiakes Dean J, Le Tuyen K, Pham Vinh N

机构信息

Department of Cardiology, Tam Duc Heart Hospital, Ho Chi Minh City, Vietnam.

Department of Cardiology, The Sue and Bill Butler Research Fellow, The Linder Research Center, Cincinnati, Ohio, USA.

出版信息

Congenit Heart Dis. 2019 Sep;14(5):772-777. doi: 10.1111/chd.12781. Epub 2019 May 28.

DOI:10.1111/chd.12781

PMID:31136097

Abstract

OBJECTIVES

The aim of our work is to investigate the clinical characteristics of coronary artery fistula (CAF) anomalies in South Vietnam.

METHODS

This is a retrospective analysis of 119 patients with diagnosis of definite CAF between January 1992 and April 2016. The demographic, clinical, echocardiographic, and angiographic characteristics and management of CAF with short-term outcomes are described.

RESULTS

The median age was 15 years (range, 1-79 years), with 49 male (41%) and 70 female (59%). There were 77 symptomatic patients (64.7%) and 91 patients (76.5%) who presented with a murmur. The electrocardiogram was abnormal in 45.4% and cardiac enlargement or increased pulmonary vasculature were seen in 76 patients (63.9%) on chest X-ray. The sensitivity of echocardiography for CAF diagnosis was 79%. The source of the fistula was most often from the RCA (54%), most commonly to right atrium (34.5%) or right ventricle (31.1%). In comparison with surgery, transcatheter closure had a shorter hospital length of stay (5.4 ± 3.8 days vs 12.6 ± 6.5 days, P = .02) and better postprocedural left ventricular ejection fraction (67.9 ± 8.1% vs 62.9 ± 6.0%, P = .03).

CONCLUSION

The majority of fistula in this study originated from the RCA and terminated in the right atrium or the right ventricle. Transcatheter and surgical closure are both relatively safe and effective, with the potential for shortened length of hospital stay following transcatheter closure.

摘要

目的

我们研究的目的是调查越南南部冠状动脉瘘（CAF）异常的临床特征。

方法

这是一项对1992年1月至2016年4月期间确诊为CAF的119例患者的回顾性分析。描述了CAF的人口统计学、临床、超声心动图和血管造影特征以及治疗方法和短期预后。

结果

中位年龄为15岁（范围1 - 79岁），男性49例（41%），女性70例（59%）。有77例有症状患者（64.7%），91例患者（76.5%）有杂音。心电图异常者占45.4%，胸部X线检查发现76例患者（63.9%）有心脏增大或肺血管增多。超声心动图诊断CAF的敏感性为79%。瘘管最常起源于右冠状动脉（RCA）（54%），最常见的引流部位是右心房（34.5%）或右心室（31.1%）。与手术相比，经导管封堵术的住院时间较短（5.4±3.8天对12.6±6.5天，P = 0.02），术后左心室射血分数更好（67.9±8.1%对62.9±6.0%，P = 0.03）。