The Clinical Value Of Echocardiog-Raphy In Diagnosis And Treatment Of Coronaryartery Fistula

Objective To explore the application value of the transthoracic echocardiography(TTE)in the diagnosis of coronary artery fistula(CAF)and understand the changes of postoperative cardiac anatomical form and function.Methods The clinical data of 37 patients with CAF undergoing surgical or percutaneous puncture CAF closure in cardiovascular research institute of our hospital between March 2010 and February 2017 were retrospectively analyzed.(1)The following measurements of the CAF patients who underwent preoperative and postoperative TTE examination within one week were collected,including: left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),right ventricular end-diastolic diameter(RVEDD),left atrial anterior and posterior diameter(LAAPD),left atrial transverse diameter(LATD),right atrial transverse diameter(RATD),left ventricular shortening rate(LVFS),left ventricular ejection fraction(LVEF),the left or right coronary artery trunk diameter(LCAD// RCAD),the fistula orifice location in the heart,the diameter of fistula orifice and the blood flow velocity and differential pressure at the fistula orifice.in addition,the valval regurgitationand postoperative residual leakage were evaluated.(2)The positive rate of preoperative coronary CT angiography(CTA)and selective coronary angiography(SCA)were Compared.(3)The surgical findings and operation method were recorded.Results All CAF cases were confirmed by surgery,the diagnostic accuracy of TTE,ICA,and coronary CTA were 89.1%,95.7% and96.8%,respectively.Single coronary artery fistula had been found in 36 cases(97.2%),right coronary artery fistula had been found in 21 cases(58.3%),left coronary artery fistula had been found in 15 cases(41.6%)and dual coronary artery fistula had been found in 1 case(2.7%).Pathological coronary artery fistula leaked into the right heart system in total 35 cases(94.5%),among which,16 cases into the right ventricular(43.2%),14 cases into the right atrial(37.8%),5 cases into the pulmonary artery(13.5%).Only 2 cases of the fistula leaked into left heart system(5.4%).Repairing surgery was performed on 21 patients(1 of whom undergoing failed percutaneous puncture CAF closure was turned into surgical revision),8 patients underwent ligation,4 patients underwent sewn closed surgery,4 patients underwent percutaneous puncture CAF closure.All measurements of cardiac morphology,and the pathological coronary starting trunk diameters in postoperative patients were decreased than preoperative value,and differences were statistically significant(P<0.05).There were 19 patients with CAF whom postoperative cardiac morphology returned to normal.Postoperative LVFS and LVEF were slightly lower than preoperative levels,but there were no statistically significant difference(p > 0.05).6 cases appeared postoperative residual shunt.Conclusion TTE is the preferred method in CAF diagnosis,and also an effective check method to evaluate the effect of surgery.