冠状动脉CT血管造影对先天性右冠状动脉缺如的评价价值

目的总结先天性右冠状动脉缺如患者的临床和冠状动脉CT血管造影（CCTA）影像表现。方法回顾性分析2014年1月~2019年6月于本院行CCTA检查并经选择性冠状动脉造影（SCA）确诊的13例先天性右冠状动脉缺如患者的临床资料和CCTA影像表现。结果13例先天性右冠状动脉缺如患者的临床表现缺乏特异性，大多表现为心血管疾病的临床症状。CCTA平扫显示左主干、左前降支和（或）左回旋支走行区内数量不等、形态各异的高密度钙化斑块形成；增强扫描显示左主干、左前降支和（或）左回旋支不同程度变窄，升主动脉和右冠状窦区均未见右冠状动脉发出，左主干、左前降支和左回旋支均不同程度增粗，并左回旋支延伸至右心室背面，进而发出分支供应右心房和右心室。CCTA与SCA表现基本一致。结论先天性右冠状动脉缺如罕见，其临床表现缺乏特异性，仅凭临床表现往往难以诊断，CCTA联合SCA检查常可用于确诊。 

Coronary computed tomography angiography for the evaluation of congenital absence of the right coronary artery

ObjectiveTo summarize the clinical characteristics and coronary CT angiography (CCTA) findings of congenital absence of the right coronary arteries (RCA).MethodsThirteen patients with congenital absence of RCA diagnosed by selective coronary angiography (SCA) in our hospital from January 2014 to June 2019 were retrospectively reviewed with emphasis placed upon the patients' clinical manifestations and CCTA findings.ResultsThe clinical manifestations of the 13 patients were of not specific, and most of them showed symptoms of cardiovascular diseases. Non-enhanced CCTA scans showed high density calcified plaques in the left main, left anterior descending and/or left circumflex coronary arteries areas. Enhanced CCTA scans showed different degrees of narrowness in the left main, left anterior descending and/or left circumflex, and no RCA were given off in the ascending aorta or right coronary sinus areas. The left main, left anterior descending and left circumflex were enlarged in different degrees, and the enlarged left circumflex extended to the posterior surface of the right ventricle, where it gave off its branches to supply the right atrium and right ventricle. Besides that, findings on selective coronary angiography (SCA) were almost identical to those of CCTA.ConclusionCongenital absence of the RCA is rare, and it's clinical manifestations are not specific, which make it difficult to diagnosis by the clinical manifestations alone. However, CCTA combined with SCA can be used to confirm the diagnosis.