Yasuda T, Takemura H, Sakakibara N, Matsumoto Y, Ushijima T, Kawasuji M, Watanabe Y
Department of Surgery (I), Kanazawa University, School of Medicine, Japan.
Kyobu Geka. 1995 Aug;48(9):763-7.
Coronary artery fistula is one of the most common coronary malformations and is being diagnosed with increasing frequency with widespread use of selective coronary arteriography. Twenty-one patients with coronary artery fistulas underwent surgical treatment at our institute between 1973 and 1994. The left coronary artery was most commonly involved, and the fistula communicated primarily with the pulmonary artery. Associated cardiovascular disease include: mitral stenosis (1), mitral insufficiency (1), partial anomalous pulmonary venous return (1), ventricular tachycardia (1), atrial septal defect (1), aortitis syndrome (1), and coronary arteriosclerotic narrowing (1). In five patients, the coronary artery fistulas were selectively ligated without CPB. In sixteen patients, in addition to selective ligation, the fistula ostia were closed from inside using CPB. There were no operative or late deaths in the patients who underwent operations. Thus, the risks of surgical correction appear to be considerably less than the potential development of serious and possibly fatal complications, even in asymptomatic patients.
冠状动脉瘘是最常见的冠状动脉畸形之一，随着选择性冠状动脉造影的广泛应用，其诊断频率不断增加。1973年至1994年间，我院有21例冠状动脉瘘患者接受了手术治疗。左冠状动脉受累最为常见，瘘主要与肺动脉相通。相关心血管疾病包括：二尖瓣狭窄（1例）、二尖瓣关闭不全（1例）、部分性肺静脉异位回流（1例）、室性心动过速（1例）、房间隔缺损（1例）、主动脉炎综合征（1例）和冠状动脉粥样硬化狭窄（1例）。5例患者在非体外循环下选择性结扎冠状动脉瘘。16例患者除选择性结扎外，还在体外循环下从内部封闭瘘口。接受手术的患者无手术死亡或晚期死亡。因此，即使是无症状患者，手术矫正的风险似乎也远低于严重且可能致命并发症的潜在发生风险。
