老年及老年前期先天性冠状动脉畸形(附7例临床分析)

目的探讨老年及老年前期先天性冠状动脉畸形的临床特征及诊疗方法。方法7例患者均行选择性冠状动脉造影及逆行升主动脉造影,然后依具体情况进行内科或外科治疗。结果右冠状动脉开口于左冠状动脉前降支(简称左前降支)2例,其中1例左前降支远段闭塞,另1例有左心功能不全;右冠状动脉缺如伴左前降支狭窄1例;左冠状动脉回旋支(简称左回旋支)起源于右冠状动脉开口处并左前降支心肌桥1例;右冠状动脉右房瘘伴左回旋支狭窄1例;右冠状动脉右室瘘伴左前降支狭窄1例;右冠状动脉左房瘘1例。其中5例患者经内科治疗后胸痛消失或明显减轻,2例经介入或外科手术治疗后症状明显改善。结论老年及老年前期先天性冠状动脉畸形患者,多伴有冠心病,心功能不全等疾病,应加强内科治疗,必要时施行外科手术治疗。

Clinical Analysis of Congenital Coronary Artery Deformity in Elderly Patient

Objective To discuss the clinical characteristics and therapy of congenital coronary deformity in elderly patient. Methods 7 patients were underwent the selective coronary angiography and retrograde ascending aortagraphy, then were treated respectively with medical or surgical treatment according to each case's state of illness. Results The right coronary artery originated from the left anterior descending branch of the left coronary artery in 2 cases. One of the 2 cases coexisted with stenosis at the far end of the left anterior descending branch and the other attended by the left cardiac dysfunction. The third patient lacked the right coronary artery, going with the left anterior descending branch stenosis. In the fourth patient, the circumflex branch of the left coronary artery originated from the proximal end of the right coronary, going with the myocardial bridge over left anterior descending branch. The fifth patient suffered from a fistula between the right coronary artery and the right atrium in addition to the left circumflex branch stenosis. The sixth patient suffered from a fistula between the right coronary and the right ventricle in addition to the left anterior descending stenosis. The last one suffered from a fistula between the right coronary artery and the left atrium. 5 of them received medical treatment and the chest pain dissolved or eased markedly. The rest respectively received surgical or interventional treatment and their clinical symptoms improved evidently. Conclusion In elderly patient, the congenital coronary artery deformity often coexisted with some diseases, such as coronary heart disease, cardiac dysfunction, etc. Medical treatments should be potentiated and surgical treatment might be necessary at the indeed time.