Chen Yu, Lu Jin, Lian Xingchen, Chang Peipei, Wen Ping, Ma Lin, Liu Yuhang
Department of Cardiothoracic Surgery, Dalian Municipal Women and Children's Medical Center(Group), Dalian, China.
Graduate School, Dalian Medical University, Dalian, China.
Front Cardiovasc Med. 2024 Nov 22;11:1439263. doi: 10.3389/fcvm.2024.1439263. eCollection 2024.
Coronary artery fistulas (CAFs) are rare congenital heart defects that are typically managed through interventional closure, traditional surgery, or minimally invasive hybrid closure surgery. However, treating CAFs with complex anatomy, such as tortuous vessels, presents a significant challenge, particularly in young children. We report the case of a 3.8-year-old child (15 kg/100 cm) with a complex CAF, treated using a minimally invasive hybrid closure surgery approach with a 4 × 4 mm Amplatzer Duct Occluder II (ADO II) (Abbott, USA). Three-dimensional (3D) imaging was utilized to visualize the CAF's anatomy, guide the surgical planning, and accurately determine the puncture site on the right ventricular free wall, as well as the optimal sheath direction and insertion depth. The procedure was carried out efficiently and safely, guided by preoperative 3D imaging and intraoperative transesophageal echocardiography. Follow-up at one year demonstrated excellent outcomes with no complications.
冠状动脉瘘（CAFs）是一种罕见的先天性心脏缺陷，通常通过介入封堵、传统手术或微创杂交封堵手术进行治疗。然而，治疗具有复杂解剖结构的CAFs，如迂曲血管，是一项重大挑战，尤其是在幼儿中。我们报告了一例3.8岁儿童（15公斤/100厘米）患有复杂冠状动脉瘘的病例，采用微创杂交封堵手术方法，使用4×4毫米的美国雅培公司的Amplatzer动脉导管封堵器II（ADO II）进行治疗。利用三维（3D）成像来可视化冠状动脉瘘的解剖结构，指导手术规划，并准确确定右心室游离壁上的穿刺部位，以及最佳鞘管方向和插入深度。在术前3D成像和术中经食管超声心动图的引导下，该手术高效且安全地进行。一年的随访显示效果极佳，无并发症。
