482 例冠状动脉瘘的 CTA 分析：一项大规模影像学研究。
CTA analysis of 482 cases of coronary artery fistula: A large-scale imaging study.
机构信息
Wuhan University of Science and Technology, Wuhan Asian Heart Hospital Imaging Centre, Wuhan, Hubei, China.
Department of Radiology, The Second Affifiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
出版信息
J Card Surg. 2022 Jul;37(7):2172-2181. doi: 10.1111/jocs.16500. Epub 2022 May 4.
OBJECTIVE
The prevalence of coronary artery fistula (CAF) based on coronary angiography has been reported. However, with the popularity of coronary computerized tomography angiography (CTA), CAFs have been found more and more by chance. The purpose of this study was to determine the prevalence and types of CAFs detected by coronary CTA, and to explore the differences in the size of fistulas, the number of complicated aneurysms, and fistulas among different types.
MATERIALS AND METHODS
From January 2016 to December 2020, 96,037 patients underwent coronary CTA in our hospital. The prevalence of CAF was retrospectively evaluated, The origin, course, and drainage site of CAF and coexisting abnormalities were analysed. The conventional treatments and follow-up DSCT images were also evaluated. Analyze the difference between the coronary-pulmonary artery fistula (CPAFs) group (380) and the coronary-cameral fistula (CCF) group (99).
RESULTS
Among 96,037 patients, 482 (0.5%) patients (male 232 and 250 female) had CAF. The types of CAF detected. The pulmonary artery was the most common site of drainage (380/482, 78.8%). Of the 99 CCFs, coronary to the left ventricle is the most common pattern in CCF (34/482, 7.0%). Single origins are more common in CAF (n = 361, 74.9%), multiple origins are more common in CPAFs than in CCF. There were statistically significant differences in the stoma diameter (2.4 ± 1.1 mm vs. 5.4 ± 4.3 mm p < .05), aneurysm complicated (85 cases [85/380] vs. 50 cases [50/99]), the size of aneurysm (8.8 ± 5.7 mm vs. 19.1 ± 11.6 mm, p < .05), and single fistula (261 [261/380] vs. 96 [96/99], p < .05). Most of the 380 CPAFs patients received conservative treatment (350/380, 92.1%), While the 59 CCF patients (59/93, 63.4%) were treated.
CONCLUSIONS
Different from previous reports, the prevalence of CAF in coronary CTA is 0.5%, the incidence of CPAFs is the highest, and the incidence of the left ventricular fistula is higher in CCF. Compared with CPAFs, CCF fistulas were more likely to be associated with a larger diameter of draining, larger aneurysms, single fistula pattern. Coronary artery CTA is a useful and noninvasive imaging method to detect CAF, which is of great significance for the detection of small fistulas and the surgical guidance of complex CAF.
目的
已有研究基于冠状动脉造影报道了冠状动脉瘘（CAF）的流行情况。然而，随着冠状动脉计算机断层扫描血管造影（CTA）的普及，CAF 越来越多地被偶然发现。本研究旨在确定冠状动脉 CTA 检测到的 CAF 的患病率和类型，并探讨不同类型的瘘管大小、并发动脉瘤数量和瘘管之间的差异。
材料与方法
2016 年 1 月至 2020 年 12 月，我院对 96037 例患者进行了冠状动脉 CTA。回顾性评估 CAF 的患病率，分析 CAF 的起源、走行和引流部位以及并存的异常情况。还评估了常规治疗和随访的 DSCT 图像。分析冠状动脉肺动脉瘘（CPAFs）组（380 例）和冠状动脉心腔瘘（CCF）组（99 例）之间的差异。
结果
在 96037 例患者中，有 482 例（0.5%）患者（男性 232 例，女性 250 例）存在 CAF。检测到的 CAF 类型。肺动脉是最常见的引流部位（380/482，78.8%）。在 99 例 CCF 中，冠状动脉至左心室是 CCF 中最常见的模式（34/482，7.0%）。单一起源在 CAF 中更为常见（n=361，74.9%），而在 CPAFs 中则更为常见（n=361，74.9%）。瘘管直径（2.4±1.1mm 与 5.4±4.3mm，p<0.05）、并发动脉瘤（85 例[85/380]与 50 例[50/99]）、动脉瘤大小（8.8±5.7mm 与 19.1±11.6mm，p<0.05）和单瘘（261 例[261/380]与 96 例[96/99]）差异有统计学意义。大多数 380 例 CPAFs 患者接受了保守治疗（350/380，92.1%），而 59 例 CCF 患者（59/93，63.4%）接受了治疗。
结论
与以往报道不同，冠状动脉 CTA 中 CAF 的患病率为 0.5%，CPAFs 的发病率最高，CCF 中的左心室瘘发病率更高。与 CPAFs 相比，CCF 瘘管更易发生引流部位较大、动脉瘤较大、单瘘管模式。冠状动脉 CTA 是一种有用的无创成像方法，可用于检测 CAF，对检测小瘘管和复杂 CAF 的手术指导具有重要意义。
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