右冠状动脉起源异常致心绞痛1例

冠状动脉起源异常是一种极为罕见的先天性心血管畸形,其数量占冠造人群的1%左右[1],属于冠状动脉的恶性畸形,因其可在无阻塞性冠脉病变的情况下导致心肌梗死、心律失常、心衰、晕厥乃至猝死等严重后果.     

Anomalous origin of the right coronary artery associated with congenital bicuspid aortic valve.

Anomalous origin of the right coronary artery is an infrequent anomaly. A case with anomalous origin of the right coronary artery from the ascending aorta above the left sinus of Valsalva is described. This patient was also found to have a bicuspid aortic valve. The aortic valve was markedly calcified and stenotic. The aortic valve was replaced with a St. Jude Medical prosthesis.     

支架植入术治疗起源于左主干的右冠状动脉1例报告

1临床资料患者女性,79岁,因反复胸闷5年,加重20d于2011年7月17日入院。既往有高血压病史30余年、糖尿病病史10余年。4年前外院诊断为冠心病,植入1枚支架,术后仍有轻度胸闷,20d前加重。查体:血压140/70mmHg(1mmHg=0.133kPa),心率68次/min。心界不大,     

右冠状动脉缺如1例临床报告

本文报告1例先天性右冠状动脉缺如     

先天性右冠状动脉右心室瘘1例

患者，男性，26岁。因“劳力性心悸、呼吸困难10年，加重半年”入院。既往无剧烈胸痛及活动后青紫、蹲踞史。查体：体温37．5℃，脉搏108次／min，呼吸20次／min，血压158／83mmHg。颈静脉怒张，双肺(-)，心尖搏动位于左侧第6肋间锁骨中线外1cm处，心尖搏动呈抬举样，胸骨右缘3、4肋间可触及收缩期震颤。心浊音界向两侧扩大。     

右冠状动脉编织样变合并后降支闭塞1例

患者,男,43岁,因"反复心前区疼痛14 d"于2019年7月26日入院。患者入院前14 d无明显诱因出现胸前区牵扯样痛,持续约数分钟到数小时,最长约3 h,伴肩部及腰部放射痛,休息后可自行缓解,无胸闷、气促、心悸、晕厥、黑曚。既往无糖尿病、高血压病史;吸烟30余年,约20支/天,无酗酒史。入院查体:T36.6℃,P 48次/min,R 20次/min,BP 96/62 mmH g。     

变异型心绞痛冠状动脉造影示右冠增粗一例报告

1　临床资料　患者男性 ,4 2岁 ,因反复胸骨后疼痛 1年、发作频率增加 2个月入院。患者胸痛多于清晨起床前出现 ,呈压迫感 ,伴左肩部牵拉痛 ,持续 2～ 3min后自行缓解 ,无明显活动后胸痛、胸闷、气急。胸痛每 2～ 3个月发作 1次。 2个月前起 15～ 2 0 d发作 1次 ,性质相似 ,1个月前曾在外院检查 ,动态心电图 (ECG)提示间歇性 度 型房室传导阻滞 ,服用 5 -单硝酸异山梨醇酯 (长效异乐定 )、酒石酸美托洛尔(倍他乐克 )、乙酰水杨酸泡腾片 (巴米尔 )时仍有胸痛发作。患者有大量吸烟史 ,无高血压、糖尿病史。入院查体 :血压17.3/12 k Pa(130…     

多层螺旋CT诊断右冠状动脉开口异位1例

患者男．70岁。活动后胸闷，胸痛、乏力1个月余，休息后绥解。心电图技平板试验均术见异常。心脏核素检查静态无缺血表现．动志左审前间壁、心尖心肌有缺血表现。行心脏冠状动脉多层螺旋CT(MSCT)检查．在心电门控下，100ml埘比剂（370mgI) 40ml生理盐水以4ml/s经肘静咏注射，注射开始23．8s后启动扫描，     

Anomalous branching of the axillary artery: A case report

We present a case regarding the anomalous branching in the third part of the axillary artery on the left side in a 35-year-old male Nepalese cadaver. In the third part the axillary artery divided into superficial brachial and deep brachial arteries. The superficial brachial artery continued in the arm without giving any branches and ended in the cubital fossa dividing into radial and ulnar arteries. The deep brachial artery gave rise to subscapular, profunda brachii, articular branch to the shoulder joint, anterior circumflex humeral artery and posterior circumflex humeral artery. This variation is very rare and incidence is around 0.12-3.2% in the available literature. The normal and abnormal anatomy of the axillary region is having practical importance for the vascular radiologist and surgeon and it should be known for accurate diagnostic interpretation. Key words: Axillary artery, brachial artery.     

先天性冠状动脉瘘一例报告

1 临床资料患者,男,40岁.活动后胸闷、心悸2个月入院.幼时体检发现心脏杂音.体检:一般情况可,心界向左右扩大,胸骨右缘第2肋间连续性杂音.心电图示窦律,右心室肥厚劳损.X线胸片示肺野清晰,心影向两侧扩大,以右侧为著.超声心动图示右冠起始部增宽(内径约2.1 cm),中部在右房室沟内形成巨大瘤样扩张(内径约6.2 cm),经二尖瓣后叶瓣根穿入左室(内径约1.3 cm).升主动脉及选择性冠脉造影示右冠始部增宽,中部形成巨大动脉瘤,成管状进入左室.全麻体外循环下手术,术中探查见:右冠主干在右房室沟处呈瘤样扩张,直径约7 cm.建立体外循环后,经主动脉根部顺行灌注停跳后改经冠状静脉窦逆灌,切开瘤壁,内无血栓,瘤体内径约6.5 cm,右冠开口直径约3 cm,远端出口直径约2 cm,切除瘤体,Teflon补片封闭右冠开口,缝闭出口,经房间隔探查左室,在后瓣下近前后交界处见冠状动脉瘘口,直径2 cm,切开后瓣根部,Teflon补片修补瘘口.然后行升主动脉-大隐静脉-右冠状动脉远端旁路移植术.术后心电图无心肌缺血表现,心脏杂音消失.患者恢复良好,术后10 d痊愈出院.     

Anomalous origin of left pulmonary artery branch from the aorta with Fallot＇s tetralogy： one case report

We report the case of a ten-year-old boy who had often presented with respiratory distress since born. Chest X-ray showed an enlarged right ventricle. Echocardiography demonstrated characteristic features of Fallot＇s tetralogy and the left pulmonary artery could not be visualized. However, cardiac catheterization disclosed that the left pulmonary artery had an anomalous origin in the ascending aorta. The patient underwent total surgical correction of the defects. Nine days later, he was discharged. We present the results of a literature review of the incidence, physiopathological, clinical, diagnostic, and surgical characteristics of this rare disease.     

右冠状动脉开口闭塞致下壁、右室心肌梗死一例报告

1临床资料患者,男性,63岁,因头晕、恶心、呕吐、无力18h入我院急诊,给予多巴胺静滴后收入院.既往有糖尿病病史3年.     

Multiple myocardial bridges affecting left anterior descending artery and right coronary artery with hypertrophic cardiomyopathy: a case report

The prevalence of myocardial bridging in hypertrophic cardiomyopathy （HCM） is relatively higher, and it usually occurs in the middle and distal portions of the left anterior descending artery. It is rarely reported that multiple lesions of myocardial bridging affecting not only the left anterior descending artery but also right coronary artery. We reported a 56-year-old man suffering from chest discomfort on exertion. Echocardiography and ventriculography showed hypertrophy of the apex involving the anterior and lateral wall. Coronary angiograph revealed multiple myocardial bridges affecting the left anterior descending artery and the right posterior descending artery.     

双源CT冠状动脉成像检查异常冠状动脉起源的意义

目的冠状动脉起源、走行和终止异常是潜在的威胁生命的解剖变异。文中评价双源CT(dual-source computed tomography,DSCT)对检出成人非先天性心脏病患者冠状动脉起源异常的价值。方法回顾性分析2008年12月至2010年2月期间进行DSCT冠状动脉检查的资料,总结成人非先天性心脏病患者冠状动脉起源异常的检出率。结果在2179例进行冠状动脉检查的患者中2177例为非先天性心脏病患者,共检出28例(1.3%)冠状动脉起源异常。其中17例为右冠状动脉起源异常(13例起自左冠状窦,4例为高位起源),10例为左冠状动脉起源异常(5例起自无冠状窦,回旋支起自左冠状窦、高位开口、回旋支起自右冠状动脉、左冠状动脉起自右冠状窦、单一冠状动脉各1例),1例为左右冠状动脉均起源异常(均为高位开口)。结论 DSCT可良好显示冠状动脉起源异常及走行,为临床决策提供重要信息。     

成人型左冠状动脉起源于肺动脉1例报告及文献复习

目的：探讨左冠状动脉起源于肺动脉（ALCAPA）的发病机制、临床特点、诊断和治疗方法,提高临床医生对该疾病的认识。方法：对1例曾误诊为心内膜弹力纤维增生症（EFE）的成人型ALCAPA患者的临床资料进行回顾性分析,并结合相关文献复习。结果：患者因间断心前区疼痛、胸闷、气短2月余并加重3d入院,入院后初步诊断为心肌病（EFE所致可能性大）、心律失常-心房颤动、心功能Ⅲ级。给予相关治疗后仍有阵发性胸骨后疼痛,并出现1次心室颤动,后行冠状动脉螺旋CT血管成像（CTA）确诊为ALCAPA,于心外科行冠状动脉旁路移植术,术后恢复良好。结论：ALCAPA相对罕见,临床表现缺乏特异性,容易误诊,冠状动脉CTA是有效诊断方法,手术是首选治疗方案。     

Stenting for left main stenosis in a child with anomalous origin of left coronary artery: case report

Anomalous left coronary artery (LCA) arising from right cusp is an uncommon condition. Clinical evidence has shown that this coronary anomaly is consistently related to sudden death. Current treatment options include modification of behaviour, medicine or surgery. Stents have been successfully applied for left main stenosis for a decade. We report a case of LCA arising from right cusp with left main stenosis treated with coronary stent in a child patient.     

Stenting for left main stenosis in a child with anomalous origin of left coronary artery: case report

Anomalous left coronary artery (LCA) arising from right cusp is an uncommon condition. Clinical evidence has shown that this coronary anomaly is consistently related to sudden death. Current treatment options include modification ofbehaviour, medicine or surgery. Stents have been successfully applied for left main stenosis for a decade.