Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand.
Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand.
Jpn J Radiol. 2021 Dec;39(12):1149-1158. doi: 10.1007/s11604-021-01164-y. Epub 2021 Jun 28.
The study sought to determine coronary artery diameter in congenital coronary-cameral fistula (cCCF), factors associated with coronary artery aneurysm, coronary artery changes after fistula closure, and computed tomographic (CT) findings after treatment.
We retrospectively reviewed CT findings of the cCCF for origins, terminations, fistula length, complexities, and Sakakibara classification. Coronary artery diameter was expressed as coronary artery Z score. Fistula features associated with coronary artery aneurysm were analyzed. Post-fistula closures were analyzed for coronary artery dilatation, coronary thrombosis, complete fistula closure, and fistula thrombosis.
Twenty-five patients (median age 33 months, interquartile range, IQR 25-48) were included. Coronary feeders and terminations were frequently right coronary artery (48%) and right ventricle (56%), respectively. Fistula aneurysm occurred in 52% of cases. Mean coronary artery Z score was 13.03 ± 6.36 with a high incidence of giant coronary artery aneurysm (68%). We found no statistically significant risk factors associated with coronary artery aneurysm (p value range 0.075-0.370). Median duration of the follow-up CT after closure of the fistulas was 6.4 months (IQR 5.0-8.7). Coronary artery Z score significantly decreased by 0.82 (IQR 0.28-1.35), p = 0.006 and coronary thrombosis occurred in 23% of cases during follow-up.
Large coronary aneurysm is common in cCCF. No characteristic feature of the fistula influencing coronary artery aneurysm is identified. There is a diminution in coronary artery Z score after fistula closure. Coronary thrombosis is a major complication after treatment.
本研究旨在确定先天性冠状动静脉瘘（cCCF）中的冠状动脉直径、与冠状动脉瘤相关的因素、瘘管闭合后的冠状动脉变化以及治疗后的计算机断层扫描（CT）表现。
我们回顾性分析了 cCCF 的 CT 表现，包括起源、终点、瘘管长度、复杂性和坂垣分类。冠状动脉直径用冠状动脉 Z 评分表示。分析了与冠状动脉瘤相关的瘘管特征。分析了瘘管闭合后的冠状动脉扩张、冠状动脉血栓形成、完全瘘管闭合和瘘管血栓形成情况。
共纳入 25 例患者（中位年龄 33 个月，四分位间距 IQR 25-48）。冠状动脉供血者和终点多为右冠状动脉（48%）和右心室（56%）。52%的病例发生冠状动脉瘘管瘤。平均冠状动脉 Z 评分 13.03±6.36，巨大冠状动脉瘘管瘤的发生率较高（68%）。我们未发现与冠状动脉瘤相关的统计学上显著的危险因素（p 值范围 0.075-0.370）。瘘管闭合后 CT 随访的中位时间为 6.4 个月（IQR 5.0-8.7）。冠状动脉 Z 评分显著降低 0.82（IQR 0.28-1.35），p=0.006，随访期间发生 23%的冠状动脉血栓形成。
cCCF 中常见大冠状动脉瘤。未发现影响冠状动脉瘤的瘘管特征。瘘管闭合后冠状动脉 Z 评分降低。冠状动脉血栓形成是治疗后的主要并发症。
