不同类型先天性冠状动脉瘘介入治疗随访研究

Transcatheter closure in various types of congenital coronary artery fistula: a followup study

摘要:

目的 评价儿童不同类型冠状动脉瘘(CAF)介入封堵治疗的近中期疗效、并发症及抗凝治疗方案。方法 回顾性分析2006 年1 月至2014 年1 月行CAF 介入封堵治疗的12 例患儿术前、造影及术后随访资料,记录不同类型CAF 的封堵方式、抗凝方案、术后并发症、辅助检查结果。结果 本组患儿年龄1~158 个月;近端型/中型4 例,近端型/大型5 例,远端型/中型3 例,均成功封堵;术后随访3.5±2.4 年;11 例患儿术后口服阿司匹林6 个月,1 例口服18 个月;无血栓、介入并发症,术后左心室射血分数、心胸比、肺动脉压下降,病变冠状动脉开口直径减小。结论 儿童期介入封堵治疗近端型和远端型/中型CAF 近中期疗效、安全性满意;术后阿司匹林抗凝治疗可预防近中期血栓事件,但疗程和安全性有待进一步随访研究。

Abstract:

Objective To evaluate the short- and medium-term efficacy, complications, and anti-coagulation therapies related to transcatheter closure (TCC) of coronary artery fistula (CAF) in children. Methods We conducted a retrospective review of the medical records of 12 children with CAF who underwent TCC between January 2006 and January 2014, focusing on details such as preoperative, radiographic, and postoperative follow-up data, to record closure methods for CAF, anti-coagulation therapies, postoperative complications, and results of auxiliary examinations. Results Among the 12 cases who underwent successful TCC and whose age was 1-158 months, four patients had proximal/medium-sized CAF, five had proximal/large CAF, and three had distal/medium-sized CAF. The mean period of postoperative follow-up was 3.5±2.4 years. Eleven patients took aspirin for 6 months post closure, and one took it for 18 months. Neither coronary thrombosis nor interventional complications were found. Left ventricular ejection fraction, cardiothoracic ratio, pulmonary artery pressure, and the diameters of coronary artery lesions decreased post TCC. Conclusions TCC is feasible and safe in proximal and distal/medium-sized CAF patients. Postoperative anticoagulation with aspirin may prevent short- and medium-term thrombosis, but treatment course and safety need to be investigated by further follow-ups.