Sakamoto T, Ihashi K, Nakano H, Shimakura T, Koide M
Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Fukuyamu, Japan.
Kyobu Geka. 1993 Feb;46(2):182-5.
The patient was a 72-year-old female who was admitted with evaluation of dyspnea on effort. On cardiac catheterization, coronary angiography showed the fistula from both RCA and LAD to the pulmonary artery and L-R shunt ratio was 37.4%, and MR and TR were found. The preoperative examination showed renal dysfunction, BUN: 61.6 mg/ml, Cr: 21. mg/ml, 24 hr Ccr: 15.2 ml/min. At the operation, the fistula was closed from the inside of the pulmonary artery and MVR (27 SJM) and TAP (Kay-Reed method) were performed associated with the intra-operative hemodialysis. The peritoneal dialysis was used for 9 days after the operation. The hemodynamics and the urination were well controlled. A successful surgical repair of bilateral coronary artery-pulmonary artery fistula associated with valvular disease and severe renal dysfunction was reported.
该患者为一名72岁女性，因劳力性呼吸困难入院评估。心脏导管检查时，冠状动脉造影显示右冠状动脉（RCA）和左前降支（LAD）均有瘘管通向肺动脉，左向右分流率为37.4%，并发现有二尖瓣反流（MR）和三尖瓣反流（TR）。术前检查显示肾功能不全，尿素氮（BUN）：61.6mg/ml，肌酐（Cr）：21mg/ml，24小时肌酐清除率（Ccr）：15.2ml/min。手术中，经肺动脉内部封闭瘘管，并进行二尖瓣置换术（MVR，27号SJM瓣膜）和三尖瓣成形术（TAP，Kay-Reed法），同时术中进行血液透析。术后使用腹膜透析9天。血流动力学和排尿情况得到良好控制。报道了一例成功手术修复双侧冠状动脉-肺动脉瘘合并瓣膜疾病及严重肾功能不全的病例。
