先天性冠状动脉瘘合并扩张的外科治疗临床分析

发布时间：2018-07-16 14:00

【摘要】：目的通过回顾性分析冠状动脉瘘合并扩张手术治疗的临床资料,提出对这种复杂畸形的诊疗经验。方法回顾性分析2001年5月至2016年10月,共11例先天性冠状动脉瘘合并冠状动脉扩张的患者在解放军总医院心血管外科实施手术治疗的临床资料,根据不同冠脉解剖特点采取不同的手术方式,总结死亡和并发症发生率等临床特征性指标,并对患者进行随访。结果 1例患者术后心梗严重低心排死亡。体外循环时间(104.8±44.9)min,阻断时间(71.9±34.1)min,呼吸机辅助呼吸(26.0±20.5)h,术后出院时间(12.5±7.7)d。术后2例患者出现室性心律失常;心包填塞1例;心肌梗死2例。其余患者无并发症发生。9例患者经电话或再次住院随访,1例患者失访。随访患者均无症状存活。平均随访58.2(10~105)个月。无因心脏事件再次手术患者。结论对冠状动脉瘘合并扩张这种少见畸形患者,冠状动脉造影及多源螺旋CT三维重建是诊断的重要方法,一经确诊应手术治疗,术式应选择个体化方案,手术近远期疗效肯定。
[Abstract]:Objective to retrospectively analyze the clinical data of coronary artery fistula complicated with dilatation operation and put forward the experience of diagnosis and treatment of this complex malformation. Methods from May 2001 to October 2016, 11 patients with congenital coronary artery fistula complicated with coronary artery dilatation were analyzed retrospectively. According to different anatomical characteristics of coronary artery, different surgical methods were used to summarize the clinical characteristics of death and complications, and follow up the patients. Results one patient died of severe low cardiac output after myocardial infarction. The CPB time was (104.8 卤44.9) min, the blocking time was (71.9 卤34.1) min, the ventilator assisted respiration time was (26.0 卤20.5) h, and the postoperative discharge time was (12.5 卤7.7) d. Ventricular arrhythmia occurred in 2 cases, pericardial tamponade in 1 case and myocardial infarction in 2 cases. There were no complications in the rest of the patients. 9 cases were followed up by telephone or re-hospitalization, and 1 case was not visited. All patients were asymptomatic and survived. The mean follow-up was 58.2 (10 / 105) months. No reoperation due to cardiac events. Conclusion for patients with coronary artery fistula complicated with dilatation, coronary angiography and three-dimensional reconstruction of multi-source spiral CT are important methods for diagnosis. Once the diagnosis is confirmed, the surgical treatment should be individualized, and the short-term and long-term results of the operation are positive.
【作者单位】：解放军总医院心血管外科全军心脏外科研究所;
【分类号】：R654.2

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