先天性冠状动脉瘘临床特点及冠脉造影分析

摘要

目的:探讨先天性冠状动脉瘘(CAF)的临床特点及瘘口起源特点.方法:回顾分析我院自2011年4月至2016年8月收治的冠状动脉造影明确诊断的37例先天性CAF患者的临床及冠脉造影资料.分析患者的主诉症状,并根据瘘口起源的位置分为左前降支(LAD)组(23例)、右冠脉(RCA)组(6例)、LAD&RCA组(2例)、左回旋支(LCX)组(5例)以及左主干(LM)组(1例),分析瘘口起源与引流位置分布的特点.结果:37例先天性CAF患者中,24例(64.9%)主诉胸闷、气促,6例(16.2%)主诉胸痛症状,5例(13.5%)主诉心悸,2例(5.4%)体检发现心脏杂音.与RCA组、LAD&RCA组、LCX组和LM组比较,LAD组的瘘口起源比例显著升高(16.2%,5.4%,13.5%,2.7%比62.2%),P均<0.01,而其他各组间比较无显著差异(P均>0.05).LAD瘘口起源23例,包括22例肺动脉瘘和1例支气管动脉瘘;RCA瘘口起源6例,包括肺动脉瘘3例,右房瘘2例和左室瘘1例;LCX瘘口起源5例,右房瘘2例、肺动脉瘘、左室瘘、右室瘘各1例.结论:冠状动脉造影是诊断先天性冠状动脉瘘的金标准,先天性冠状动脉瘘起源于左冠脉的比例显著高于右冠脉.%Objective:To explore clinical and fistula origin characteristics of congenital coronary artery fistula (CAF).Methods:Clinical and coronary angiographic (CAG)data of 37 congenital CAF patients,who were treated in our hospital from Apr 2011 to Aug 2016 and diagnosed by CAG,were retrospectively analyzed.Chief complaint symptoms were analyzed.According to fistula origin location,patients were divided into left anterior descending (LAD)group (n=23),right coronary artery (RCA)group (n=6),LAD & RCA group (n=2),left circumflex (LCX)group (n=5)and left main (LM)group (n=1).Characteristics of fistula origin and drainage location dis-tribution were analyzed.Results:Among the chief complaints of 37 congenital CAF patients,there were 24 cases (64.9%)of chest tightness and short of breath,six cases (16.2%)of chest pain,five cases (13.5%)of palpitations and two cases (5.4%)of heart murmur in physical examination.Compared with RCA group,LAD & RCA group, LCX group and LM group,there was significant rise in percentage of LAD fistula origin (16.2%,5.4%,13.5%, 2.7% vs.62.2%),P <0.01 all,but there were no significant difference among other groups,P >0.05 all.The 23 cases of LAD fistula origin included 22 cases of pulmonary artery fistulas (PAF)and one case of bronchial artery fis-tulas (BAF);the six cases of RCA fistula origin included three cases of PAF,two cases of right atrial fistulas (RAF) and one case of left ventricular fistulas (LVF);the five cases of LCX fistula origin included two cases of RAF,and one case of PAF,LVF and RVF respectively.Conclusion:Coronary angiography is the gold standard to diagnose congenital CAF.Percentage of congenital CAF originated from left coronary artery is significantly more than that of right coronary artery.