Objective To review the experience of surgical treatment for coronary fistulas. Methods Fifty-four cases of coronary fistulas[35 males ,19 females ,mean age of (23. 0+21. 4) years] admitted at Department of Cardiovascular Surgery ,U-nion Hospital ,HUST(China)were retrospectively analyzed. Of 57 fistulas from 54 cases ,51 got single fistula,and 3 got multiple fistulas. Eleven fistulas drained into right ventricle ,16 into right atrium ,23 into pulmonary artery ,2 into left ventricle ,and 5 into coronary veins. There were 34 fistulas arising from right coronary artery ,and 23 from left coronary artery (1 case of multiple fistulas arising from the left and right coronary artery respectively). There were 3 rare cases whose fistulas drained from circumflex branch to right atrium. Twenty-two(38. 9% )patients had associated lesions. Surgical procedures:34 patients got transcardi-ac chamber closure with cardiopulmonary bypass , among which Dacron patch was used in 4 patients to reduce the tension. Fourteen patients got transcoronary aneurysm suture ligation with cardiopulmonary bypass . Six patients got suture ligation without cardiopulmonary bypass. Results All patients recovered uneventfully. The mean follow-up duration was (3. 0 + 2. 3) years. No patients got residual fistulas ,and all patients were in New York Heart Association classes Ⅰ and Ⅱ. Thrombosis occurred in 3 patients in the blind end of fistula. Conclusion Patients presenting symptoms or obvious left to right shut should get surgical treatment. The surgical technique should be chosen according to the characteristics of the pathologic anatomy and asso-ciated lesions. Excellent results for the surgical management of coronary artery fistulas can be achieved.%目的 总结先天性冠状动脉瘘的外科治疗及相关经验.方法 回顾分析武汉协和医院心血管外科2000年1月至2011年5月54例先天性冠状动脉瘘患者,其中男性35例,女性19例.平均年龄(23.0±21.4)岁.51例患者瘘口为单个,3例为多发瘘口.共计57个瘘口.其中11个汇入右心室(19.3%),16个汇入右心房(28.1%),23个汇入肺动脉(40.3%),2个汇入左心室(3.5%),5个汇入冠状静脉(8.8%).有34个瘘口来源于右冠状动脉,23个瘘口来源于左冠状动脉,其中有1例多发瘘口,分别起源于左、右冠状动脉.有3例罕见病例为回旋支汇入右房.合并有其它畸形的患者22例(38.9%).手术方式:34例在体外循环下行经心腔或肺动脉瘘口缝闭术,其中4例因瘘口较大,用补片予以修补,以避免张力过高;14例行冠状动脉切开瘘口修补;6例患者行单纯结扎.结果 患者无死亡.术后随访(3.0±2.3)年,心功能均为Ⅰ~Ⅱ级.无残余漏发生.3例患者随访中发现瘘口残端血栓形成.结论 有症状或有明显左向右分流的冠状动脉瘘患者,均应争取手术治疗.根据病变的病理特点、有无心内畸形决定手术方式.冠状动脉瘘手术效果优良.
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