Adult Coronary Artery Fistula－A Retrospective Analysis of 14 Cases

回顧性分析台灣南部地區成年冠狀動脈瘻管之特性及預後

劉秉彥(Ping-Yen Liu) ； 詹世鴻(Shih-Hung Chan) ； 趙庭興(Ting-Hsing Chao) ； 蔡惟全(Wei-Chaun Tsai) ； 李貽恒(Yi-Heng Li) ； 林立人(Li-Jen Lin) ； 蔡良敏(Liang-Miin Tsai)

《Acta Cardiologica Sinica》 19卷4期 (2003/11) Pp. 221-228

摘要

背景：冠狀動脈瘻管(coronary artery fisttula) 是一種罕見的先天性血管異常。我們分析4300位接受心導管手術檢查的台灣南部成年人的冠狀動脈血管攝影圖，並加以分析病患背景及瘻管特徵，同時與西方國家的資料做一比較。
方法與結果：我們發現：共有14位病患(0.3%)有冠狀動脈瘻管存在，這與過去報告類似；其中共包含有20個瘻管；西方國家資料大部分的病患為女性，具多數瘻管源自右側冠狀動脈；然而在本研究卻顯示：在南台灣族群之冠狀動脈瘻管，大部分的病患為男性，且多數瘻管源自左側冠狀動脈。這些瘻管並未產生明顯血流動力學及血氧濃度的改變。
結論：在追蹤平均6.3年的時間後，並未發現與冠狀動脈瘻管有相關之合併症，足見其預後是十分良好的。

關鍵字

冠狀動脈瘻管 ； 預後

並列摘要

Background and Purpose: Coronary artery fistula is a rare congenital anomaly. The purpose of this retrospective study was to analyze the prevalence, angiographic characteristics, and the natural history of coronary artery fistulas in Southern Taiwan adult patients undergoing diagnostic cardiac catheterization and compare with results from Western countries.
Methods and Results: Of 4300 patients who had diagnostic cardiac catheterization, 14(0.3%) had coronary artery fistulas, with totally 20 fistulas in angiograms, with males predominant (12/14, 85.7%). Only one patient was found to have a continuous murmur. Most of the fistulas were single (9/20, 64.2%). Ten fistulas (50%) originated from the left anterior descending artery, 5 from the right, 4 from the circumflex and 1 from the left main coronary artery, respectively. The majority of the fistulas (15/20, 75%) drained into the pulmonary artery. There were one-third of patients (5/14, 35.7%) with occlusive coronary artery disease but with less other congenital anomalies. The men ratio of pulmonary to systemic flow was 1.25±0.15. Neither significant oxygen step-up nor combination of congenital heart abnormalities was noted. During a mean follow-up period of 6.3 years (range from 6 months to 10 years), there were no complications related to coronary artery fistula.
Conclusions: In conclusion, the prevalence rate of coronary artery fistulas detected during routine diagnostic coronary angiography is very low in Southern Taiwan. Most of our patients are male in sex. The coronary artery fistulas originate predominantly from the left coronary artery and drain into pulmonary artery. In our series, the fistulas were not associated with hemodynamic abnormalities or other congenital heart diseases. The prognosis of coronary artery fistulas in adults is good.

並列關鍵字

coronary artery anomaly ； coronary artery fistulas ； prognosis