Objective To formulate an individualized evidence-based treatment for a first-diagnosed patient with coronary artery-pulmonary artery fistula. Methods Aiming at the issue of whether interventional operation was necessary for first-diagnosed coronary artery-pulmonary artery fistula or not, the computer retrieval was conducted in the US National Guideline Clearinghouse, The Cochrane Library, PubMed and MEDLINE from 1990 to 2011, to collect and assess the best evidence of relevant systematic reviews, randomized controlled trials, controlled clinical trials and treatment guidelines, in order to be applied in clinical treatment. Results There were 1 clinical guideline for treating coronary artery fistula and 3 different high-quality evidence studies were retrieved. The results showed percutaneous coronary intervention was the best treatment currently. According to the obtained evidence and patient’s willingness, the relevant examinations were taken, and the preoperative preparation for percutaneous coronary intervention was done actively after the patient was admitted. Three days after hospitalization, the selective coronary angiography showed right coronary artery-pulmonary artery fistula and left coronary circumflexus artery-left atrial multiple fistulae, then the percutaneous coronary intervention spring coil embolization was successfully conducted for right coronary artery-pulmonary artery fistula. After operation, bayasprin enteric-coated tablets 0.1 g/d was taken for anti-platelet aggregation and preventing thrombotic diseases. The observation during operation and postoperative 5-day hospitalization showed no relevant complications. Conclusion Percutaneous coronary intervention is safe and effective for the symptomatic patients with coronary artery-pulmonary artery fistula.
Objective To summarize diagnosis and treatment outcomes of coronary arterial fistulas （CAFs） so as to improve surgical results. Methods Clinical data of 23 patients with CAFs who underwent surgical repair in Xinhua Hospital，School of Medicine，Shanghai Jiaotong University from July 2006 to January 2013 were retrospectively analyzed. There were 15 male and 8 female patients with their age of 35.4±8.7 years. CAFs originated from left anterior descendingartery in 7 patients，right coronary artery in 13 patients，dual coronary arteries in 1 patient，left main coronary artery in 1 patient，and obtuse marginal artery in 1 patient. CAFs drained into pulmonary artery in 16 patients，right ventricle in 5patients，and right atrium in 2 patients. Twelve patients received surgical repair under off-pump condition with beating heart，and the other 11 patients underwent surgery under cardiopulmonary bypass （CPB）. Surgical techniques included extracardiacgasket interrupted suture ligation，intracardiac mattress suture ligation，intracardiac gasket interrupted suture for fistula repair，and a combination of intracardiac suture ligation and extracardiac repair. Results There was no in-hospital death or seriouspostoperative complication in this group. For the 11 patients undergoing surgical repair under CPB，average CPB time was 78.6±7.4 minutes，and average aortic cross-clamping time was 39.0±5.9 minutes. Postoperatively，patients’ heart functionrecovered well，their symptoms disappeared，and there was no myocardial ischemia or residual fistula. Twelve patients werefollowed up at the outpatient department and via telephone for 3 months to 6 years after discharge. During follow-up，theirheart function all recovered well，and echocardiogram detected no abnormality. There was no late death，myocardial ischemiaor residual fistula. Conclusion All CAFs patients need early surgical repair once their diagnosis is clear. Appropriate surgical strategies should be chosen according to the characteristics of pathological anatomy and associated intracardiaclesions. Surgical outcomes are satisfactory.
Abstracts： Objective To summarize clinical experience and surgical outcomes of congenital coronary arterial fistula （CAF）. Methods We retrospectively analyzed clinical records of 12 patients （6 males, 6 females）, aged from 4 to 77 （50.90±23.8） years, who underwent surgical repair of CAF in Nanjing First Hospital between February 2005 and June 2011. There were 3 CAF patients associated with coronary artery aneurysms, one with patent foramen ovale and 2 with coronary artery disease （CAD）. One CAD patient had concomitant severe aortic valve stenosis. One patient underwent surgical repair without cardiopulmonary bypass （CPB） and 11 patients underwent surgery under CPB, among whom 3 patients underwent surgery with beating heart. One patient underwent concomitant aortic valve replacement and coronary artery bypass grafting.?Results?All the patients recovered uneventfully. Operation time was 151.25±42.65 min （ranging from 90 to 245 min）, cardiopulmonary bypass time was 65.06±29.16 min （ranging from 31 to 116 min）, mean aortic cross-clamping time was 43.00±33.41 min （ranging from 18 to 97 min） and postoperative hospital stay was 12.50±1.45 d （ranging from 10 to 15 d）. There was no early or late death. All the patients were followed up from 4 months to 6 years and no patient had symptom recurrence, myocardial ischemia or residual fistula during the follow-up. Conclusions All CAF patients should be surgically treated once diagnosis are made with satisfactory surgical outcome.
Objective To improve the treatment effectiveness of coronary artery fistula by summarizing and analyzing the clinical experiences of its surgical procedures. Methods We retrospectively analyzed the clinical data of 47 patients, 25 males and 22 females, with coronary artery fistula who were hospitalized from January 2003 to December 2008. The age of the patients ranged from 9 months to 63 years old(mean age of 34 years). Thirtytwo cases without associated intracardiac abnormalities were given surgical closure of fistula without cardiopulmonary bypass. Ten cases with largesize fistula were repaired directly or with a patch under cardiopulmonary bypass. Coexisted heart abnormalities were treated simultaneously. Results There were 26 cases of right coronary artery fistula,17 cases of left coronary artery fistula and 4 cases of fistula of both coronary arteries; 17 cases of coronary artery fistula opening into the right ventricle, 8 cases opening into the right atrium, 12 cases opening into the pulmonary artery, 2 cases opening into the sinus of coronary veins, 3 cases opening into the left atrium, 5 cases opening into the left ventricle; and there were 4 cases of multiple fistulas. No death happened during the operation. All patients received surgical treatment successfully, except for one multiplefistula patient who had remaining fistula after operation. Followup was conducted on 47 patients with the time period ranging from 1 month to 5 years. The color ultrasonic cardiography showed that all patients recovered well except for one multiplefistula patient who had a small remaining fistula. Conclusion Coronary artery fistulas can cause hemodynamic problems with indication for surgical intervention. Surgical operation is quite effective for fistulas of coronary artery.
ObjectiveTo evaluate the application value of virtual reality (VR) technology in the surgical treatment of coronary artery fistula (CAF) and abnormal origin of coronary artery (AOOCA).MethodsFrom January 2014 to June 2018, with the assistance of virtual reality technology, 4 patients with CAF and 4 patients with AOOCA in the Department of Cardiac Surgery of our hospital underwent treatment method deciding and operation details planning. In the CAF patients, there was 1 male and 3 females and they were 8 years, 16 years, 62 years, and 65 years, respectively. In the AOOCA patients, there was 1 male and 3 females at age of 4-month, 2 years, 14 years, and 29 years, respectively.ResultsThe virtual heart models in all 8 patients were well matched with the real heart. The spatial structure information of CAF/AOOCA and surroundings can be intuitively and fully shown by virtual reality technology in all patients. All of the 4 CAF patients repaired coronary artery incision, including 2 patients with autologous pericardium patch and 2 patients with direct suture. Of the 4 AOOCA patients, 3 underwent coronary directly transplantation but 1 underwent Takeuchi surgery. And 2 had mitral valve plasty at the same time. All the operations were completed successfully, with good recovery and no serious complications. Among the 4 CAF patients, 3 had no residual fistula, and 1 had minor residual fistula. Coronary arteries were all unobstructed in 4 patients of AOOCA; moderate and severe mitral regurgitation in 2 patients were significantly reduced after surgery.ConclusionVR allows doctors to understand the spatial structure information of CAF/AOOCA and surroundings before the operation, and assists them to make accurate treatment decisions and develop detailed surgical plans before the operation, ensuring its safety. Its clinical application value is significant.