冠状动脉起源异常的冠状动脉造影分析

目的探讨冠状动脉起源异常(anomalous origin of coronary artery,AOCA)的冠状动脉造影特征及其临床意义。方法2000年10月~2006年12月在我院行冠状动脉造影的患者1560例,检出有AOCA患者29例,并对其临床资料进行回顾性分析。结果29例AOCA患者检出率为1.9%,其中23例(79.3%)为良性AOCA,包括:前降支和回旋支分别开口于左冠窦15例,回旋支起源于右冠窦3例,右冠状动脉起源于无冠窦1例和高位开口于升主动脉4例;6例(20.7%)为有潜在临床危险AOCA,分别为左主干起源于右冠窦1例,单支左冠状动脉2例,右冠状动脉起源于左冠窦3例。起源异常冠状动脉有明显狭窄患者9例(31.0%),但仅2例为狭窄只累及起源异常动脉。结论AOCA无特征性临床表现,通常在冠状动脉造影时被发现;某些类型有导致严重心脏事件的潜在危险。AOCA与冠状动脉狭窄无相关性。     

成人冠状动脉起源异常10例

目的 :了解冠状动脉起源异常 (coronaryarteryoriginanomalies,CAOA)的情况。 方法 :回顾性分析我院从 1998至 2 0 0 3年 838例冠状动脉造影资料。结果 :838例中CAOA 10例 ( 1.19% ) ,其中右冠状动脉起源于左乏氏窦 4例、无冠窦 1例 ,右冠状动脉高位开口 2例 ,左前降支和左回旋支分别独立起源于左乏氏窦 2例 ,单支冠状动脉 1例。结论 :最常见的类型是右冠状动脉起源于左乏氏窦 ,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。     

老年人冠状动脉起源异常研究

目的 分析老年人冠状动脉起源异常的类型及检出率,总结其冠状动脉分布的优势情况,并探讨冠状动脉起源异常与冠状动脉粥样硬化的关系.方法 回顾性分析北京大学第一医院接受冠状动脉造影检查的老年患者资料,记录冠状动脉起源异常的检出频度和类型,及发生冠状动脉粥样硬化性狭窄的情况.结果 冠状动脉造影总数2031例,检出冠状动脉起源异常46例(2.3%).右冠状动脉起源异常26例(56.5%),右冠状动脉起源异常多于左冠状动脉(19例,41.3%).其中以右冠状动脉起源于左冠状动脉窦为最常见类型,占总异常的28.3%(13例).并存冠状动脉粥样硬化性狭窄者37例(80.4%),其中17例(37.0%)累及起源异常的冠状动脉.结论 我国老年人冠状动脉起源异常多见于右冠状动脉,其中具有潜在临床危险的右冠状动脉起源于左冠状动脉窦为最常见类型.冠状动脉起源异常与冠状动脉粥样硬化存在相关性.

Abstract：

Objective To estimate the patterns and frequency of anomalous coronary origin with angiography in the Chinese elderly population and evaluate the correlation between anomalous coronary origin and development of coronary atherosclerotic stenosis. Methods A retrospective analysis was performed on the basis of angiographic data among elderly patients who underwent coronary arteriography in Beijing University First Hospital. Those with anomalous origin of coronary arteries were selected for further assessment and significant stenosis in coronary arteries was recorded.Results Among 2031 patients, 46 patients were found to have anomalous origin of coronary artery,with an incidence rate of 2.3%. Right coronary artery was the most common anomalous vessel, being involved in 26 patients (56.5%). The anomalous origin was more frequent in right coronary artery than in left coronary artery (41.3%). The most common anomaly was right coronary artery arising from left coronary sinus in 13 patients (28.3%). Significant atherosclerotic lesions in the anomalous arteries were seen in 37 patients (80.4%). Conclusions In Chinese elderly population, the anomalous origin of coronary artery is more frequent in right coronary artery, the most common anomaly resides in right coronary artery arising from left coronary sinus. The anomalous coronary artery increases risk for development of coronary atherosclerotic stenosis.     

冠状动脉先天性异常患者的冠状动脉造影分析

目的　了解在行冠状动脉造影的人群中冠状动脉先天性异常的发生情况 ,并探讨其临床意义。方法　对北京大学第一医院自 2 0 0 0年 1月至 2 0 0 3年 1 1月行冠状动脉造影的患者中存在冠状动脉先天性异常者的造影结果进行回顾性分析。结果　 2 82 4例冠状动脉造影患者中 ,检出各种类型冠状动脉先天性异常共 6 1例 ,占 2 1 %。其中 84 1 %为冠状动脉起源和分布异常 ,右冠状动脉先天性异常远较左冠状动脉先天性异常多见。 4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。冠状动脉起源异常对介入诊疗有一定影响。     

成人冠状动脉异常起源于肺动脉的临床分析

目的:探讨成人冠状动脉异常起源于肺动脉的临床特点、诊断方法、治疗及意义。方法:北京安贞医院自2004年1月至2012年12月,共收治12例成人冠状动脉起源异常患者,对其临床资料、治疗情况及随访结果进行回顾性分析。结果:全组男性2例,女性10例,年龄16~66岁,平均年龄为(39.2±17.9)岁。其中10例为左冠状动脉起源于肺动脉,2例为右冠状动脉起源于肺动脉。患者临床表现缺乏特异性,在确诊前均误诊为其他疾病。全组均经冠状动脉造影,心脏超声心动图(UCG),冠状动脉CTA等检查而确定诊断。其中9例患者行外科手术重建冠状动脉,2例患者拒绝手术,1例因严重心功能不全而失去手术时机。手术患者中2例患者因合并重度二尖瓣反流而同时行二尖瓣置换术,1例患者因合并冠心病同时行冠状动脉旁路移植术。无围手术期死亡病例及术后并发症。随访6~48个月,平均随访(27±13)个月,患者术后均症状消失或明显缓解,一般体力活动不受限。UCG提示:术后左心室舒张末径从[(47.4±7.2)mm减小到(41.8±6.5)mm,P0.01],左心室的短轴缩短率(FS)从[(24.3±11.3)%增至(36.1±11.6)%,P0.01)]。未手术治疗患者1例死于心力衰竭。1例失访,1例仍时有活动后气短、心慌等症状。结论:成人冠状动脉异常起源于肺动脉无特征性临床表现,除了冠状动脉造影,UCG和冠状动脉CT等无创检查对确定诊断具有重要意义。手术治疗重建双冠状动脉系统是目前首选的治疗方案,可以改善心脏血供,从而防止猝死、心功能不全等严重心脏事件的潜在危险。     

成人冠状动脉起源异常分析

目的分析成人冠状动脉起源异常的发生情况。方法回顾性分析大连市金州区第一人民医院2003年3月至2006年12月接受冠状动脉造影的690例患者。结果完成冠状动脉造影690例,检出冠状动脉起源异常10例,检出率为1.4%,冠状动脉起源异常的10例中右冠状动脉起源异常7例,3例起源于无冠窦,1例起源于左冠窦,3例高位开口(2例开口于右冠窦上方,1例开口于无冠窦的上方);左冠状动脉起源异常3例,占30%,其中1例左回旋支起源于右冠窦,1例起源于右冠状动脉,1例左主干高位开口。结论冠状动脉造影是发现冠状动脉起源异常及确定其类型的重要手段。     

冠状动脉造影中冠状动脉先天性变异的分析

目的:分析冠状动脉先天性变异的冠状动脉造影表现,探讨冠状动脉造影的诊断价值。方法:2003年1月～2007年12月在武汉钢铁公司总医院行冠状动脉造影的患者900例,对其结果进行回顾性分析。结果:共检出67例冠状动脉先天性变异,检出率为7.44%。其中检出冠状动脉瘘9例,检出率为1.00%,并以冠状动脉-右心室瘘最为多见。12例为冠状动脉起源和分布异常,占1.33%,并以右冠状动脉的先天性变异为多见。检出冠状动脉心肌桥(壁冠状动脉)46例,检出率为5.11%,并以左前降支心肌桥多见。结论:冠状动脉先天性变异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性变异的重要手段。     

血脂代谢异常与冠状动脉病变程度的相关性分析

目的 探讨冠状动脉病变与血脂代谢紊乱的关系.方法 选择102例冠心病患者,其中单支病变组32例,双支病变组41例,三支病变组29例,同时测定并统计分析血脂各成分及其比值与冠状动脉病变之间的关系.结果 随着冠状动脉病变范围的增加,血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、TC/高密度脂蛋白胆固醇(HDL-C)比值、LDL-C/HDL-C比值升高,HDL-C降低,与对照组比较,差异有统计学意义(P＜0.05).冠心病组血脂各组分和其比值与冠状动脉积分的相关分析表明,TC/HDL-C比值、LDL-C/HDL-C比值与冠状动脉病变的相关性最强.结论 血脂代谢紊乱的严重程度与冠状动脉病变的严重程度是一致的,通过异常的血脂代谢有可能初步预测冠状动脉病变,其中TC/HDL-C比值、LDL-C/HDL-C比值优于其他血脂指标.     

冠状动脉左回旋支起源异常1例

患者,女,54岁。因阵发性胸痛4年入院。体检:血压120/80 mmHg(1 mmHg=0.133 kPa),心率70次/min,心肺腹未见明显异常。心电图、超声心动图均未见异常。由于多家医院怀疑冠心病、心绞痛,故人我院行选择性冠状动脉造影。造影所见,左冠状动脉未见回旋支,只见左主干及其分出前降支,未见确切狭窄;右冠状动脉超优势型,未见确切病变。左回旋支直接开口于右冠窦的右冠状动脉开口处,发出后,在主动脉后穿出走向左房室沟,其后走行与常人左回旋支走行相同,该回旋支亦未见狭窄。     

少见冠状动脉畸形18例

目的 :探讨 18例少见冠状动脉 (冠脉 )畸形特征及评价选择性冠脉造影在其诊断中的作用。方法 :对17例患者进行冠脉造影 ,13例患者进行手术纠正治疗。另 1例二维超声心动图误诊为动脉导管未闭 ,术中证实为右冠脉 -右室瘘。结果 :18例患者中共发现有 9种冠脉畸形 ,包括冠脉起源异常 2例 ;左冠脉回旋支缺如 1例 ;左、右冠脉 -肺动脉瘘 3例 ;左冠脉 -肺动脉瘘 3例 ;右冠脉 -右心房瘘 3例 ;右冠脉 -右室瘘 2例 ;右冠脉 -静脉瘘 1例 ;左冠脉 -右室瘘 1例 ;左冠脉 -左心室瘘 2例。其中 13例患者经手术治疗得到再证实。结论 :冠脉畸形是少见的先天性血管畸形 ,选择性冠脉造影是确诊的重要手段 ,需与先天性心脏病和冠心病心绞痛鉴别 ,术后效果良好。     

Single coronary artery, anomalous origin of the right coronary artery from the left anterior descending artery

We present a patient with an abnormal origin of the right coronaryartery from the left anterior descending artery. The patienthad chest pain probably related to myocardial ischaemia. Thisanomaly is very rare and has previously been reported in onlythree cases. The abnormal vessel travelled rightwards and remainedanterior to the main pulmonary artery, it was free of significantstenosis. The mechanism of anterior myocardial ischaemia remainsunexplained.     

Single coronary artery, anomalous origin of the right coronary artery from the left anterior descending artery

We present a patient with an abnormal origin of the right coronaryartery from the left anterior descending artery. The patienthad chest pain probably related to myocardial ischaemia. Thisanomaly is very rare and has previously been reported in onlythree cases. The abnormal vessel travelled rightwards and remainedanterior to the main pulmonary artery, it was free of significantstenosis. The mechanism of anterior myocardial ischaemia remainsunexplained.     

Single coronary artery, anomalous origin of the right coronary artery from the left anterior descending artery.

We present a patient with an abnormal origin of the right coronary artery from the left anterior descending artery. The patient had chest pain probably related to myocardial ischaemia. This anomaly is very rare and has previously been reported in only three cases. The abnormal vessel travelled rightwards and remained anterior to the main pulmonary artery, it was free of significant stenosis. The mechanism of anterior myocardial ischaemia remains unexplained.     

Treatment of coronary artery disease in an anomalous coronary artery by placement of an intracoronary stent

We report the use of coronary stenting to treat disease in an anomalous coronary artery. The patient had a single coronary artery with anomalous left anterior descending artery arising from the right sinus of Valsalva and coursing between the aorta and pulmonary artery. Although balloon angioplasty has been used in patients with anomalous coronary arteries, this is the first report of stent placement in this circumstance. Cathet. Cardiovasc. Diagn. 41:185–188, 1997. © 1997 Wiley-Liss, Inc.     

Arteriographic demonstration of both kinking at the origin and compression between the great vessels of an anomalous right coronary artery arising in common with a left coronary artery from above the left sinus of valsalva

Angled angiographic views demonstrated two areas of significant systolic narrowing in an anomalous right coronary artery arising in common with a left coronary artery from above the left sinus of Valsalva: (1) an ostial stenosis due to kinking as the anomalous artery turned sharply to the right after its origin from the aorta; (2) compression of the proximal segment as it coursed between the aorta and pulmonary artery. Appropriate angiographic studies to evaluate the presence of these changes may help to elucidate their significance.