儿童冠状动脉瘘的诊断及介入治疗现状

Current Status of Diagnosis and Interventional Therapy for Coronary Artery Fistula in Children

摘要: 冠状动脉瘘(CAF)是冠状动脉与心腔或大血管间的异常连接，多为先天性，后天性病因包括创伤、感染等。其临床表现与分流量相关，轻者无症状，重者可致心力衰竭、心肌缺血及感染性心内膜炎等。诊断依赖于超声心动图、MRI、CT及冠状动脉造影，其中超声心动图为首选筛查手段。目前的治疗方式包括介入封堵或外科手术，介入治疗创伤小但需严格把握适应症，外科手术多用于复杂病例。介入治疗术后并发症包括血栓、残余分流、心律失常等，远期预后良好，但需长期随访。本文系统综述了儿童冠状动脉瘘的临床表现、诊断、介入治疗现状及预后等。

Abstract: Coronary artery fistula (CAF) is an abnormal connection between a coronary artery and a cardiac chamber or major blood vessel, most commonly congenital in origin. Acquired causes include trauma, infections, and other etiologies. Clinical manifestations depend on the shunt volume: mild cases may be asymptomatic, while severe cases can lead to heart failure, myocardial ischemia, infective endocarditis, and other complications. Diagnosis relies on imaging modalities such as echocardiography, MRI, CT, and coronary angiography, with echocardiography serving as the first-line screening tool. Current treatment options include interventional closure or surgical procedures. Interventional therapy is minimally invasive but requires strict adherence to indications, while surgery is primarily used for complex cases. Postoperative complications of interventional therapy may include thrombosis, residual shunt, arrhythmias, and so on. Although the long-term prognosis is favorable, it necessitates ongoing long-term follow-up monitoring. This article systematically reviews the clinical manifestations, diagnostic approaches, current status of interventional therapies, and prognoses of coronary artery fistulas in children.