Coronary Fistula Repair

The only treatment for coronary artery spasm is surgery, which closes the abnormal passage between the coronary artery and the heart chamber. Combined with other cardiac malformations, it is often necessary to have simultaneous or staged surgical treatment. Treatment of diseases: congenital coronary artery spasm Indication Patients with coronary artery spasm with increased ventricular filling load, congestive heart failure, myocardial insufficiency, and bacterial endocarditis. Contraindications Surgical indications for asymptomatic infants or young children are not consistent. Patients with large coronary aneurysms have a high risk of surgery. Preoperative preparation Electrocardiogram, echocardiography and multi-row CT were used to determine the diagnosis before operation. Surgical procedure (1) Coronary artery ligation: the proximal end of the free iliac crest, the distal branch of the coronary artery, ligation, cutting or suture ligation, blocking test 5-10min before ligation, if no myocardial color and ECG changes, surgery Can be carried out. (2) Coronary artery tangential suture method: for the treatment of sputum into the ventricular coronary artery. In the lower edge of the coronary artery at the mouth of the fistula, several sutures were inserted through the pupil of the myocardium. The sutures with small gaskets were firm and should not be torn. Intracardiac suture method: Under cardiopulmonary bypass, the heart cavity is connected by sputum, and the pupil is closed with a small shimming suture. Be careful not to miss multiple pupils. (3) Coronary artery bypass surgery: If the arterial spasm is difficult to suture closed, the distal saphenous artery can be bypassed with a great saphenous vein aorta. For patients with large aneurysms, the pupils can be directly cut open to repair the pupils. Supine, anterior chest midline incision, longitudinally sawing the sternum, and cutting the happy capsule, the diseased coronary artery shows a fibrillated blood vessel on the surface of the myocardium, which is easily recognizable, and the fistula often trembles. Coronary artery ligation of the anterior wall of the heart and the fistula at the end of the main branch or branch of the coronary artery can be used for coronary artery ligation; near the fistula, the coronary artery is temporarily blocked until the tremor disappears completely, and the electrocardiogram is closely monitored. ~10 minutes, if there is no sign of myocardial ischemia, it can be double-ligated or cut with suture. Coronary artery with fistulas located in the lower wall of the main branch should be used for coronary artery incision suture: under the diseased coronary artery through the superficial myocardium, juxtaposed with a number of needles and blood vessels in the vertical direction of the interlocking suture Temporarily tighten the suture until the tremor disappears. After the electrocardiogram monitors no signs of myocardial ischemia, the suture can be ligated one by one to close the fistula. Coronary artery spasm is located in the left atrioventricular sulcus, involving the circumflex artery or the distal segment of the right coronary artery. It is difficult to expose or aneurysmal enlargement, requiring partial resection. If the mouth of the fistula is not at the end of the coronary artery, intracoronary fistula suture should be performed under cardiopulmonary bypass. Before establishing extracorporeal circulation, suture should be placed on the surface of the myocardium to accurately indicate the location of the coronary artery spasm, in order to prevent the local tremor from disappearing after the establishment of extracorporeal circulation, it is difficult to determine the lesion. The extracorporeal circulation was combined with low temperature to block the ascending aorta, the coronary artery was cut longitudinally, the fistula was sutured, and the coronary artery incision was sutured. If the coronary artery of the lesion is aneurysm-like enlargement, the coronary aneurysm wall can be partially resected and sutured. In very few cases, an aneurysm needs to be removed and a large cryptic vein is implanted. Coronary artery fistula can be broken into the atrium, ventricle or pulmonary artery. Under the extracorporeal circulation combined with low temperature, the ascending aorta can be blocked, the heart chamber or vascular lumen of the coronary artery fistula can be opened, and the fistula can be sutured in the cavity.

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