冠状动脉先天性变异的冠状动脉造影分析

对1997年11月至2004年12月2596例在我院所行的冠状动脉造影结果进行回顾性分析，共检出57例冠状动脉先天异常，占2．2％。其中36例为冠状动脉起源和分布异常，占63．2％，并以右冠状动脉的先天性异常为多见。检出冠状动脉瘘21例，检出率为0．81％，并以冠状动脉一肺动脉瘘最为多见，占81％。冠状动脉先天异常的临床症状和体征多不典型或缺如，冠状动脉造影是确诊各种冠状动脉先天异常的最重要手段。     

1167例成人冠脉造影中冠脉变异性分析

目的：通过成人冠状动脉造影资料分析冠动脉正常解剖变异与开口变异的检出频度。方法：回顾性分析2005年1月～2013年8月我院1167例成人冠状动脉造影资料，将检出的冠状动脉分布、走形解剖变异与先天性冠状动脉开口起源异常进行总结分类。结果：1167例冠状动脉造影中检出冠状动脉开口起源异常22例，总检出率1．88％。结论：成人冠状动脉存在分布变异与开口变异，总检出率为1．88％，以左侧冠脉起源变异最为常见。     

成人冠状动脉血管造影异常分析

目的探讨在行冠状动脉造影的成年人群中冠状动脉异常的发生情况及其临床意义。方法对行冠状动脉造影的患者中存在冠状动脉先天性及部分后天异常者的造影结果进行回顾性分析。结果1875例冠状动脉造影患者中,检出各种类型冠状动脉异常共73例（3．89％）,其中2．67％为冠状动脉先天性异常,占异常的68．49％：包括起源和分布异常、冠状动脉发育异常;右冠状动脉先天性异常远较左冠状动脉先天性异常多见;2例未能成功施行右冠状动脉选择性造影。结论临床上冠状动脉先天性异常并非罕见,其中部分类型可引起心肌缺血。冠状动脉异常对介入诊疗的操作方法、结果评判有一定影响。     

恩施地区土家族冠状动脉先天性畸形患者58例分析

目的探讨恩施地区土家族冠状动脉先天性畸形患者的类型及发生率。方法对2007年1月至2011年1月共875例成人患者行冠脉造影检查,对检出有冠状动脉先天性畸形患者进行回顾性分析,并根据解剖学特征进行分类。结果 875例患者中共检出先天性异常58例,总检出率6.63%;冠状动脉起源和分布异常18例(31.03%);冠状动脉异常细小11例(18.97%);冠状动脉瘘、畸形引流4例(6.90%);冠状动脉心肌桥25例(43.10%)。结论恩施地区土家族冠状动脉先天性畸形患者的类型及发生率和相关文献报道大致相同。     

先天性冠状动脉畸形的检出及造影表现

目的:探讨国人冠状动脉畸形的发生率及冠状动脉造影表现. 方法:回顾性分析自1991年我院开展冠状动脉造影以来所有接受冠状动脉造影检查的患者,观察并记录冠状动脉畸形的发生率与表现形式. 结果:1524例患者中,共检出冠状动脉畸形患者21例,检出率为1.38%,主要表现为冠状动脉起源异常(11例)与冠状动脉瘘(10例),这两种畸形的发生率相似,男性患者主要表现为冠状动脉瘘,女性患者主要表现为冠状动脉起源异常. 结论:冠状动脉畸形是一种少见的先天性心血管畸形,冠状动脉造影是诊断冠状动脉畸形的金标准.     

冠状动脉造影对先天性冠状动脉瘘的诊断价值9例分析

先天性冠状动脉瘘（coronary artery fistulae,cAF）较少见。病变为冠状动脉主干和／或其分支与心腔或冠状静脉有交通,在先天性心脏病中,发生率为0．27％～0．40％。既往诊断有一定困难,随着冠状动脉造影（coronary angiography,CAG）的广泛开展,其发现病例在逐年增多,现结合我院发现的9例患者来探讨冠状动脉瘘的冠状动脉造影表现。     

桡动脉穿刺冠状动脉内介入治疗的临床应用

目的：探讨经桡动脉穿刺选择性冠状动脉造影及冠状动脉腔内成形术（PTCA）及支架术的临床意义。方法：对102例具备冠状动脉造影适应证的患者，采用经桡动脉穿刺法行右、左冠状动脉造影，并根据冠状动脉造影结果决定是否行经皮冠状动脉腔内成形术（PTCA）及支架术。结果：冠状动脉狭窄（50-70）％21例（21／102，占21％），〉75％以上68例（68／102，占67％），68例行PTCA及支架植入术，〈50％13例（13／102，占12％），冠状动脉正常25例（25／70，占35．5％）。结论：通过冠状动脉造影，可以定性诊断，指导治疗；桡动脉穿刺具有出血并发症少等优点。     

冠状动脉瘘3例临床分析

冠状动脉瘘是指冠状动脉主干或其分支与某一心腔或血管之间存在的异常通道 ,是一种少见的先天性心脏疾病。其发病率低 ,约占先天性疾病的0 .2 7%～ 0 .4 0 % ,临床表现不典型 ,常规心脏超声及胸片检查难以发现 ,常易漏诊。随着选择性冠状动脉造影的广泛应用 ,其检出率逐渐提高。本院心内科开展冠状动脉造影以来检出 3例 ,现报告如下。1　临床资料3例患者 ,均为男性 ,行冠状动脉造影前均常规行心脏彩超及胸片检查 ,均未发现冠状动脉瘘 ,听诊也未闻及心脏杂音。例 1,男 ,5 5岁 ,有胸痛史 ,临床诊断为“冠状动脉粥样硬化性心脏病” ,心电图提示…     

年龄和性别与冠状动脉钙化、狭窄的相关性分析

目的：探讨年龄和性别与冠状动脉钙化（CAC）及冠状动脉狭窄的相关关系，以及年龄和性别对CAC诊断冠心病（CHD）的影响。方法：记录591例可疑CHD患者临床相关指标，对所有入选患者行冠状动脉造影，分析年龄和性别与冠状动脉钙化、狭窄的相关关系。站果：CAC总检出率为43．82％，其中男性和女性患者CAC检出率分别为42．32％和49．14％，差异无统计学意义。60岁以下男性患者CAC检出率高于女性，但60岁以上女性钙化检出率已超过男性。检出冠脉狭窄患者433例，占入选患者总数的73．27％，其中男性和女性患者狭窄检出率分别为76．84％和58．62％，差异有统计学意义（P〈0．05）。各年龄组的狭窄检出率男性均高于女性，但60岁以上女性狭窄检出率迅速增高。结论：年龄和性别对冠状动脉钙化诊断冠心病的价值有很大影响，临床上评价冠状动脉钙化对冠心病的诊断时必须充分考虑年龄和性别因素。     

冠状动脉起源异常29例

目的：了解冠状动脉起源异常（coronary artery origin anomalies,CAOA)的情况。方法：回顾性分析我院从1995至2001年2416例冠状动脉造影结果。结果：CAOA29例（1．2％），其中左前降支（LAD）和回旋支（LCX）分别独立起源于左冠状窦17例（58．6％），右冠（RCA）起源于左冠状窦6例（20．7％），RCA起源于升主支脉1例（3．4％），LCX起源于右冠状窦4例（13．8％）LCX起源于RCA1例（3．4％）；29例患者中除5例（17．2％）合并有冠状动脉狭窄外，其余24例（82．8％）患者未见冠状动脉狭窄。结论：CAOA是影响冠状动脉造影响的因素之一，但细胞观察左心室造影结果，选用不同型号的造影导管，终能满意地显示冠状动脉。最常见的类型是LAD和LCX分别独立起源于左冠状窦，大多数异常类型并不导致严重的临床症状，只有少数需要外科手术治疗。     

Clinical and angiographic profile of congenital anomalous origin of coronary arteries

Coronary artery anomalies were found in 24(0.6%) patients undergoing coronary arteriography at University Cardiac Center, Bangabandhu Sheikh Mujib Medical University, Dhaka from 2004 to 2007. Of the 24 patient, 21(87.5%) had anomalies of origin and distribution and 3(12.5%) had coronary artery fistulae. Most coronary anomalies did not result in signs, symptoms or complications and usually were discovered as an incidental finding at the time of catheterization. Most of them were benign anomalies: i) separate origin of left anterior descending and circumflex from sinus of valsalva; ii) ectopic origin of circumflex from right sinus of valsalva; iii) Anomalous origin of left main coronary artery from right coronary artery; iv) anomalous coronary origin from ascending aorta; v) absent left circumflex; vi) double right coronary artery; vii) small coronary artery fistula. These anomalies may be associated with potentially serious sequelae such as angina pectoris, myocardial infarction, syncope, cardiac arrhythmias, congestive heart failure, or sudden death. In this study large coronary artery fistula was found as potentially serious anomaly. So coronary artery anomalies require accurate recognition for the appropriate management of the patients.     

64 层螺旋 CT 对冠状动脉异常起源的诊断价值

目的:探讨64 层螺旋 CT 冠状动脉造影诊断先天性冠状动脉起源异常的临床价值。 材料与方法 回 顾性分析2011-06 ~ 2011-12 行64 层螺旋 CT 冠状动脉血管成像的 1000 例病人的 CTA 图像,对图像分别行多 平面重建(MPR)、最大密度投影(MIP)和容积重现(VR)法重建图像,并对结果进行分析、总结。 结果:1000 例 完整冠状动脉 CTA 结果中,诊断冠状动脉先天性异常起源者共36 例,发生率为3. 6%。 其中男 16 例,女 20 例, 年龄36 ~ 74 岁,平均52. 2岁。 其中左冠优势型2 例,均衡型5 例,右冠优势型29 例。 发现的冠状动脉起源异常 种类有:右冠状动脉变异 12 例(33. 3%);左冠状动脉变异 19 例(52. 8%);冠状动脉其他分支起源异常 5 例 (13. 9%)。 所有图像通过不同的重建方法可以清晰直观地显示异常血管的起始和行程。 结论:64 层螺旋 CT 冠 状动脉成像可清晰显示冠状动脉异常起源,可为心血管医师提供有价值的影像,为一种无创、安全、有效的检查 方法。     

右冠脉起源异常经桡动脉介入治疗的疗效观察

目的观察国人右冠状动脉异常起源于左冠状动脉窦并对其经桡动脉行冠状动脉介入性治疗（PCI）的效果。方法回顾性分析2200例接受冠脉介入治疗的患者,总结其中19例右冠状动脉异常起源于左冠状动脉窦并经桡动脉行PCI患者的治疗经验。结果 19例患者异常起源右冠状动脉共植入22枚支架,植入成功率100%,无重要并发症发生。结论对起源异常冠状动脉合并狭窄病变施行PCI是安全可行的,可在临床推广应用。     

Congenital coronary artery fistulas: dual-source CT findings from consecutive 6624 patients with suspected or confirmed coronary artery disease

Background  Coronary artery fistulas (CAFs) are rare congenital abnormality often unintentionally found in patients with coronary artery disease. Clinical diagnosis of CAFs is difficult due to symptomless or lack of specific symptoms. Dual-source computed tomography (DSCT) might be a useful diagnostic tool for CAFs. The study aimed to retrospectively summarize the imaging features of CAFs delineated at DSCT in 48 CAF patients detected from consecutive 6624 patients with suspected or confirmed coronary artery disease in our institution.

Methods  Forty-eight patients underwent DSCT angiography by using retrospective electrocardiographic (ECG) gating after infusion of 70 ml of intravenous contrast material during breath hold. Maximum intensity projection (MIP), curved planar reconstruction (CPR), and volume rendering technique (VR) were obtained. Anomalous termination of coronary artery in each subject was evaluated by two radiologists (with more than 10 years experience with cardiovascular imaging), and disagreement between diagnosis readers was settled by a consensus reading. Ten of 48 patients also underwent traditional coronary angiography (CAG) simultaneously.

Results  In each CAF case, DSCT angiography clearly demonstrated the origin, the termination, the size of abnormal vessel and its course in relation to surrounding great vessels. CAF arising from right coronary artery was the most common type, left circumflex was the least one involved among three coronaries, and pulmonary artery was the most common drainage site. Aneurismal fistulous tract, coronary atherosclerosis, myocardial bridging and anomalous origin of coronary artery were also detected in this group. The demonstration of drainage sites in CAG was consistent with DSCT angiography in 9 patients, and judgment on one anomalous connection in CAG was inconsistent with that in DSCT angiography.

Conclusions  DSCT angiography could provide accurate delineation of anomalous communications, size and numbers of fistulas in patients with CAFs. It suggested that DSCT is a useful tool for the assessment of CAFs and may be considered as the first-choice imaging modality, especially for patients with coronary artery disease.

     

先天性冠状动脉变异的双源CT分析

目的探讨双源CT冠状动脉成像对先天性冠状动脉变异的检出率及诊断价值。方法对2007年5月~2008年9月行心脏双源CT冠状动脉成像的资料（2314例）进行分析,总结先天性冠状动脉变异的发生率及其CT表现。结果2314例中发现先天性冠状动脉变异170例,检出率7.35%,冠状动脉主支起源异常27例,冠状动脉瘘6例,副冠状动脉9例,冠状动脉发育不良7例,左窦房结动脉起源异常121例。结论双源CT冠状动脉成像能准确全面诊断先天性冠状动脉变异,可作为先天性冠状动脉变异的首选检查方法。     

右冠状动脉起源于左冠状动脉2例及冠状动脉变异文献复习

目的探索冠状动脉变异现象及其临床意义。方法对2例右冠状动脉起源于左冠状动脉的患者进行病例分析，并复习有关文献。结果2例右冠状动脉起源于左冠状动脉患者均有不典型心绞痛及不典型心肌缺血心电图改变，冠状动脉造影未见严重冠状动脉狭窄。结论冠状动脉变异有一定的临床意义，但是尚有待进一步研究。     

Surgical treatment of anomalous origin of coronary artery from the pulmonary artery

Background Anomalous origin of coronary artery from the pulmonary artery is a rare congenital cardiac malformation with a mortality rate of up to 90% within the first year of life without surgical intervention. Direct implantation of the anomalous coronary artery （ACA） into the aorta is successful in early life, but it may have increased surgical difficulty and risk with age. This retrospective study summarized our operative experience in direct implantation for treatment of this coronary anomaly in pediatric and adult patients.
Methods From August 2000 to January 2003, 4 consecutive patients aged from 9 months to 41 years underwent dual coronary repair. Among them, two children and one infant with anomalous origin of the left coronary artery from the pulmonary artery （ALCAPA） and one adult was anomalous origin of right coronary artery from the pulmonary artery （ARCAPA）. Coronary arteries were directly implanted into the ascending aorta in 4 patients. In a boy with ALCAPA associated with moderate mitral insufficiency （MI）, whose ACA arose remotely from the ascending aorta, we created a tube-shaped graft using part of the pulmonary arterial wall in continuity with the origin of the left coronary artery （LCA）. Concomitant moderate MI was repaired in 2 patients, including this boy, after a dual-coronary repair.
Results All patients survived. There were no hospital or late deaths and no major complications as well. Echocardiography revealed that the left ventricular （LV） function including LV end-diastolic dimension （EDD） and ejection fraction （EF） was markedly improved at hospital discharge. At 3-6 years follow-up after surgery all patients were asymptomatic and currently in NYHA class 1.
Conclusions The best results are achieved with direct implantation of the ACA into the ascending aorta and simultaneous mitral valve repair if needed. Direct implantation is feasible in pediatric and adult patients with ALCAPA or ARCAPA including the coronary artery in a location remote from th