【摘要】 作者报告外科治疗先天性冠状动脉瘘２５例，３例合并巨大冠状动脉瘤。年龄４～４７岁（平均１９．８岁）。１７例（６８．０％）起自右冠状动脉分别瘘入右房、右室、肺动脉和左室。８例（３２．０％）起自左冠状动脉瘘入右室或肺动脉。１２例行动脉瘘缝扎术。１３例在体外循环直视下关闭瘘口，其中４例经瘘入的心腔修补，９例切开扩张的冠状动脉或冠状动脉瘤修补．３例合并巨大冠状动脉瘤者切除瘤壁缝合。无手术死亡。２２例随访１～２２年（平均８年２月），效果优良，无复发和远期死亡。讨论了本病的诊断、血液动力学变化和手术方法。认为合并冠状动脉瘤应尽早外科治疗。更多还原

【Abstract】 From October 1957 through December 1990, twenty-five patients with congenitalcoronary artery fistula(CCAF), including 3 cases complicated with giant coronaryartery aneurysms, underwent surgical repair. The ages ranged from 4 to 47 years(mean19.8 years). CCAF originated from he right coronary artery in 17 cases(68.0%)and termin-ated into RA, RV,pulmonary artery(PA)and LV,respectively. 8 cases (32.0%)ori- ginated from the left coronary artery and drained into RV or PA. The CCAF were closed by ligation in 12 , and repaired under cardiopulmonary by-pass in 13.4 of them under went intracardiac repair and in 9 cases the dilated coronaryartery or aneurysm were incised longitudinally near the fistulous orifice which wasthen closed by mattres sutures with pledgets or patch repair. In 3 patients complicatedwith giant coronary artery aneurysms , the wall of aneurysm was trimed and closedwith continuous suture . There were no operative deaths.Twenty-two patients were followed up for1～22years(mean 8 years 2 months).The results were satisfactory with no recurrence. Indiscussion , the authors emphasized cardiopulmonary bypass is required for repairing offistula which is located in the posterior aspect of the heart.Patients with markedlydilated coronary artery or in the presence of an aneurysm ,the fistula can be repairedthrough a coronary arteriotomy or opening of the aneurysm with excellent results.更多还原