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1、双PDA封堵器治疗冠状动脉痿合并巨大冠状 动脉瘤成功(附2例报告)郑 宏，兰 天,徐争鸣，刘 明，吴文辉，吕 滨，张 岩,李世国，徐丽丽，蒋世良，赵世华，徐仲英，凌 坚,孙 鑫【摘要】目的 报告并讨论采用双 PDA封堵器堵闭冠状动脉痿合并巨大冠状动脉瘤成功经验。方法对2例冠状动脉痿合并巨大冠状动脉瘤患者采用股动脉-升主 动脉-冠状动脉-冠状动脉痿-右房-下腔静脉-股静脉 轨道法，经股静脉分别将 14F及12F输送鞘送至冠状动脉瘤 的两端并各置入 2枚国产 PDA封堵器(1例为20/18和 18/16mm,另1例置入2枚22/20mm)施行冠状动脉痿堵闭术。 结果第1枚封堵器置入后造影显示经冠状
2、动脉痿左向右分 流明显减少，第二枚封堵器置入后分流基本消失。封堵术后 第一例肺动脉压由 50/24 (34)降至26/9 (17) mmHg第 二例由60/26 (37)降至35/15 (18) mmHg术后第二天超 声复查显示分流完全消失。分别随访41及19个月，患者情况良好，体征消失，症状明显改善。结论采用双PDA封堵器堵闭冠状动脉痿合并巨大冠状动脉瘤2例取得良好效果，可作为该畸形替代外科手术治疗的一种方法。【关键词】 冠状动脉痿；冠状动脉瘤；国产封堵器；封堵 coronary artery fistula xxplicated with a giant coronary artery a
3、neurysm by utilization of double Chinese home-made PDA occluders: report of two casesSuccessful transcatheterclosure of congenitalZHENG Hong, LAN Tian, XU Zheng-ming, et of Radiology, Cardiovascular Institute and Fuwai Hospital, CAMS and PUMC, Beijing 100037, ChinaAbstract Objective To describe our
4、experience with transcatheter occlusion of congenital coronary arterial fistulas xxplicated with a giant coronary artery aneurysm by utilization of double Chinese home-made PDA Two symptomatic patients, one man aged 36 and one woman aged 56 years old underwent transcatheter occlusion of both fistula
5、s and giant coronary artery aneurysm at same procedures by utilization of double Chinese home-made PDAoccluders. All two patients had chest distress and dyspnea on exertion.The fistulaoriginatedfrom the leftcircumflexartery (LCX) to coronary sinus in man andfrom LCX into right atrium in womanand bot
6、h xxplicated with a giant coronary artery aneurysm nearby remote end , the diameter of aneurysm were 36 and 39 mmrespectively. Two Chinese home-made PDA occluders , which were two of the type of 22/20 mm in man and two of the type of 20/18 and 18/16 mm in woman, were deployed into the coronary arter
7、ies to occlude the opening of the aneurysm and the end of the fistulas one after another in both patients through a 14F and 12F deliver The procedures were unxxplicated and successful. Two patients were followed up after 41 and 19 months and underwent examination of UCQand Chest film to show that th
8、e left to right shunt were disappeared and cardiothoracic ratio was smaller. The chest distress and dyspneas of these two patients have also resolved after the Transcatheter closure of congenital coronary fistulas xxplicated with a giant coronary artery aneurysm by utilization of double Chinese home
9、-madePDAoccluders are safe and effective, and can be regarded as an acceptable alternative to surgery.Key words coronary artery fistula; coronary artery aneurysms; Chinese home-made septal occluder; occlusion介入治疗冠状动脉痿（CAF）的报道日渐增多，已被越 来越多的医生和学者所接受，过去报道的多采用弹簧圈和单 个先心病圭寸堵器进行圭寸堵，而采用双PDA封堵器治疗冠状动脉痿合并巨大冠状动脉
10、瘤者尚未见报道。现就我院采用国产 双PDA封堵器对冠状动脉痿合并巨大冠状动脉瘤治疗成功的 经验报道如下。1临床资料病例1:女，56岁，发现心脏杂音 30余年，平素活动 可，但活动量大，上四楼时感心慌、气短、胸闷。查体：胸 骨左缘23肋间可闻及口 /6级双期杂音及心尖部川/6级收 缩期杂音，无震颤，A2【参考文献】1 朱晓东，张宝仁.心脏外科学.北京：人民卫生出版 社，20XX: 544.2 Meyer J, Reul Gl, Mullins CE et al. Congenital fistulae of the coronary arteries : clinical considerati
11、ons and surgical mangement in 23 patients.J Thorac Cardiovasc Surg,1975, 16 (1): 506-510.3 Collins N, Mehta R, Benson L, et al. Percutaneouscoronary artery fistula closure in adults: technicaland procedural aspects. Catheter Cardiovasc Interv.20XX, 69 (6) :872-880.4 KrabillKA, Hunter DW.Transcatheter closure ofcongenital coronary arterial fistula with a detachable balloon. Pediatr Cardiol,1993,14(3) :176-178.et al.fistulaeCatheter5 Behera SK, Transcatheter closure using the Amplatzer Cardiovasc lnterv,20XX,68Danon S , Levi DS, of coronary arteryDuct Occluder.(2) :242-248.
