彩色多普勒超声心动图诊断冠状动脉起源异常的价值

目的　探讨彩色多普勒超声心动图在诊断冠状动脉起源异常中的价值。方法　应用彩色多普勒超声心动图对 6例患者进行检查 ,观察左、右冠状动脉主干的起源部位、走行、血流方向 ,测量冠状动脉主干内径、左室射血分数 (LVEF) ,观察合并的其他心血管畸形及瓣膜反流情况 ,并与冠状动脉造影、手术结果进行对比。结果　 4例左冠状动脉主干起源于肺动脉 ,1例左前降支起源于肺动脉 ,1例副冠状动脉起源于肺动脉。主要合并的心血管畸形有室间隔缺损、房间隔缺损、完全性心内膜垫缺损等。超声心动图诊断结果与冠状动脉造影及手术探查结果完全符合。超声心动图测量的左、右冠状动脉内径和LVEF与冠状动脉造影测值间高度相关(r分别为 0 .94、0 .96、0 .89,均 P <0 .0 1) ,两种方法测值间差异无显著性意义 (P >0 .0 5 )。结论　彩色多普勒超声心动图可明确诊断冠状动脉起源异常 ,为手术治疗提供可靠依据     

双源CT在冠状动脉起源异常诊断中的应用2356例分析

目的探讨双源CT冠状动脉成像诊断冠状动脉起源异常的价值。方法对2 356例成人冠状动脉双源CT血管成像资料进行回顾性分析、总结。结果 2 356例冠状动脉CTA中,检查出冠状动脉起源异常31例,检出率为1.31%,其中冠状动脉开口水平变异9例,两支冠状动脉开口于左冠状窦5例,两支冠状动脉开口于右冠状窦8例,前降支起源于右窦1例,左回旋支起源于右窦2例,前降支及回旋支独立开口于左冠状窦2例,单一冠脉2例(均为单一右冠),左回旋支闭锁2例。结论双源CT冠状动脉成像可以清晰显示冠状动脉起源及走行,是一种良好的无创性的诊断冠状动脉起源异常的可靠方法。     

左冠脉起源于右冠窦1例

1病例报告 男，41岁，体形正常。主因胸骨后压榨样痛伴大汗淋漓在外院诊断为冠心病急性高侧壁心肌梗死。病情稳定后转我院。既往体健，无高血压、糖尿病史，吸烟多年，30余支／d。心电图示：窦性心律，ST段弓背向上抬高，T波倒置。第8天行冠脉造影：右侧桡动脉入路，5F多功能造影管多体位造影，显示右冠状动脉起源正常，左回旋支起源于右冠状窦开口下方，血管粗大，向左下走行．第一钝缘支较小．中段80％狭窄，TIMI血流三级。左前降支源自右冠状动脉近段，向上向左再向下走行于左室前璧，血管细长，另有一支血管（相当于中间支）起源于右冠状动脉起始部下方，直向左下移行，主动脉根部造影显示左冠状动脉窦内无血管发出，右冠状窦内分别发出右冠状动脉、左冠状动脉回旋支。左前降支源于右冠。     

64层螺旋CT对冠状动脉起源异常及预后的评价

目的：探讨64层螺旋CT诊断冠状动脉起源异常的价值及对预后的评价。方法：对1211例冠状动脉CT血管成像（CTA）资料进行回顾性分析。结果：1211例完整冠状动脉CTA结果中，共检出冠状动脉起源异常18例，检出率为2.17%。包括右冠状动脉起源于左窦5例，伴前降支和回旋支单开口1例；右冠状动脉起源于升主动脉1例；圆锥动脉单开口4例；左冠状动脉主干起源于右窦3例；回旋支起源于右窦1例。前降支和回旋支单开口4例；共有8例冠状动脉分别起源于对侧窦，其中有3例该段有50%左右狭窄。结论：64层螺旋CT是冠状动脉起源异常安全和有效的确诊方法，并可对预后做出评估。     

左冠状动脉起源于肺动脉的超声诊断

目的 评价超声心动图对左冠状动脉起源于肺动脉的诊断价值并提高超声心动图对左冠状动脉起源于肺动脉的诊断能力.方法 分析5例左冠状动脉起源于肺动脉患儿的超声影像特征表现,观察左侧冠状动脉主干的起源、走行及血流方向.结果 本组5例患儿均表现为:左侧冠状动脉起源于肺动脉;右侧冠状动脉增宽;室间隔及左室后壁侧支血流丰富.结论 超声心动图能够明确诊断左冠状动脉起源于肺动脉,是诊断左冠状动脉起源于肺动脉的首选重要方法.     

成人型左冠状动脉异常起源于肺动脉疾病的超声评价

目的探讨超声在评价成人型左冠状动脉异常起源于肺动脉疾病中的价值。方法回顾性分析经手术和冠状动脉造影证实的8例成人型左冠状动脉异常起源于肺动脉疾病患者的超声心动图特征,并与其他具有相同临床表现的疾病进行鉴别诊断。结果 8例患者超声心动图表现为:①左冠状动脉主干起自肺动脉;②左室均明显扩大,室间隔和左室前壁节段性运动障碍;③二尖瓣腱索回声显著增强;④左室收缩功能正常;⑤右冠状动脉内径均明显增宽,右冠状动脉与主动脉环直径比值≥0.14;⑥左、右冠状动脉间可见丰富的侧支循环形成;⑦收缩期二尖瓣口可见少-大量反流信号;⑧左冠状动脉前降支和回旋支血流为逆向灌注(向心性)。结论成人型左冠状动脉异常起源于肺动脉疾病有特异性的超声心动图特征,对心脏扩大,左、右冠状动脉间存在侧支循环的病例应加强对冠状动脉的超声检查。     

经胸超声心动图诊断左冠状动脉异常起源于肺动脉的初步研究

目的总结左冠状动脉异常起源于肺动脉(ALCAPA)的经胸超声心动图(TTE)特征及诊断思路。方法回顾性分析我院经手术证实的8例ALCAPA患者的临床及影像学资料,总结其TTE特征。结果 8例ALCAPA患者左室收缩功能均正常,其中婴儿型1例,早期出现肺炎、ST改变和心影增大;成人型7例,多无明显症状,因发现心脏杂音就诊。8例患者首诊超声仅确诊1例,高年资医师复诊检查确诊6例,1例误诊冠状动脉-肺动脉瘘。ALCAPA的典型TTE特征为左室增大,右冠状动脉内径增宽,心肌侧支血流丰富,肺动脉内见来自左冠状动脉的异常血流信号。结论婴儿期发现心力衰竭、ST改变、心影增大,以及儿童或成人期发现冠状动脉侧支血流丰富、右冠状动脉内径增宽,均需警惕ALCAPA;仔细扫查左冠状动脉的起源和血流方向,有助于提高TTE对ALCAPA的早期诊断准确率。     

经胸超声心动图诊断左冠状动脉异常起源于肺动脉的初步探讨

目的总结左冠状动脉异常起源于肺动脉（ALCAPA）的经胸超声心动图（TTE）特征及诊断思路。方法 回顾性分析我院经手术证实的8例ALCAPA患者的临床及影像学资料，总结其TTE特征。结果8例ALCAPA患者左室收缩功能均正常，其中婴儿型1例，早期出现肺炎、ST改变和心影增大；成人型7例，多无明显症状，因发现心脏杂音首次就诊。8例患者首诊超声仅确诊1例，高年资医师复诊检查确诊6例，1例误诊冠状动脉-肺动脉瘘。ALCAPA的典型TTE特征表现为左室增大，右冠状动脉增宽，心肌侧支血流丰富，肺动脉内见来自左冠状动脉的异常血流信号。结论 婴儿期发现心力衰竭、ST改变、心影增大；儿童或成人期发现冠状动脉侧支血流丰富、右冠状动脉增宽，均需警惕ALCAPA，应仔细扫查左冠状动脉的起源和血流方向，有助于提高TTE对ALCAPA的早期诊断。     

左冠状动脉异常起源于肺动脉的超声心动图表现分析

目的对左冠状动脉异常起源于肺动脉(ALCAPA)患者的超声心动图表现及其相关病理生理进行分析总结。方法以我院9例ALCAPA患者为研究对象,所有患者均经冠状动脉造影、CTA或手术证实。回顾性分析其影像学资料,总结超声心动图及其病理生理学特点。结果 9例患者中超声心动图首诊明确左冠状动脉异常起源于肺动脉6例,经随诊或其他方法证实6例起源于肺动脉主干或左后窦,3例起源于肺动脉右后窦或右支起始部。其他超声心动图表现包括左冠状动脉可见舒张期为主逆向血流、不同程度二尖瓣反流,左室收缩功能降低6例(EF值60%),左心室明显增大7例;6例左、右冠状动脉之间可见广泛侧支循环,以室间隔为著,3例侧支血管血流稀疏,血液经由右冠状动脉由侧支血管进入左冠状动脉,再逆流进入肺动脉,形成左向右的分流,以上均提示患者血流动力学异常。结论超声心动图能够诊断ALCAPA,可明确左冠状动脉起源于肺动脉,并对ALCAPA病理生理、血流动力学改变的观察有重要价值。     

超声心动图与心血管造影对左冠状动脉异常起源于肺动脉诊断价值的对比研究

目的：探讨左冠状动脉异常起源于肺动脉的超声图像特征及经胸超声心动图的诊断价值。方法：对本院收治的7例左冠状动脉异常起源于肺动脉患者进行了回顾性分析，总结各型的超声表现并与心血管造影结果相对照。结果：7例患者中成人型6例，婴儿型1例。超声检查均显示了肺动脉壁异常管腔开口、肺动脉内异常分流和室间隔内冠状动脉侧支血流，并评估了心肌灌注不足所致的心脏形态、功能变化以及瓣膜反流，4例显示了左冠状动脉分支结构。2例误诊为右冠状动脉一肺动脉瘘，2例疑诊冠状动脉异常起源，3例正确诊断。心血管造影全部诊断正确，显示了左冠状动脉异常开口于主肺动脉，右冠状动脉经侧支血管逆行充盈。结论：经胸超声心动图能正确诊断左冠状动脉主干异常起源于肺动脉，与心血管造影相比能提供更多的信息，可作为临床诊断的首选方法。     

64层螺旋CT对先天性冠状动脉异常起源的显示

目的总结冠状动脉异常起源的螺旋CT影像表现。方法回顾性分析2005年5月1日-2006年5月1日行冠状动脉检查的患者的CTA结果,共2274人,其中冠状动脉异常起源者共24例,发生率为1.06%。其中男22例,女2例,年龄36~79岁,平均52.8岁。对患者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。结果右冠状动脉开口于左冠窦6例,开口高位5例;左主干开口高位4例,开口于左冠窦后缘2例;左前降支与左回旋支分别开口于左冠窦5例;左回旋支开口于右冠窦1例;左右冠状动脉共干1例。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可清晰显示冠状动脉异常起源及行程异常,可为心血管医生提供有价值的影像。     

Diagnosis and management of anomalous origin of the right coronary artery from the left coronary sinus

The anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva coursing between the aorta and the pulmonary artery or right ventricular outflow tract, is considered a potentially fatal abnormality which may require surgery. However, diagnosing the correct course with coronary arteriography may be difficult. Fast gradient echo magnetic resonance (MR) imaging can be helpful to identify and confirm the course of aberrant coronary arteries and their relationship to the surrounding tissue. In this study, diagnostic procedures and management are described of four patients in whom the RCA originated from the left sinus of Valsalva. Although reported as investigational by the Task Force document on MR imaging by the European Society of Cardiology we are of the opinion that MR coronary angiography may have an important future role in the assessment of anomalous coronary arteries.     

Analysis of anomalous origin of coronary arteries by coronary angiography in Chinese patients with coronary artery disease

With the development of coronary angiography for the diagnosis of coronary artery disease, its clinical significance in detecting coronary artery anomalies and evaluating the seriousness is attracting more attention. In the study we aimed to assess the prevalence of anomalous origin of coronary arteries in a Chinese population who underwent coronary angiography for coronary artery disease, and explore any patterns in the common variants and typical anomalies, especially the potentially serious ones. Patients who underwent coronary angiography from January 2013 to December 2016 in Fuwai Hospital were included. Baseline characteristics and angiographic data were collected, the incidence of anomalous origin of coronary arteries was calculated, and the typical patterns were analyzed. Comparisons between the present results and those of existing reports were also conducted. A total of 110,158 patients were included in the study, among which 0.76% (835 cases) had anomalous origin of coronary arteries. Among the anomalies, the incidences of anomalous origin of the right coronary artery (RCA), the left coronary artery (LCA), both the RCA and LCA, single coronary artery (SCA) and dextrocardia were 76.76% (641 cases), 14.61% (122 cases), 1.80% (15 cases), 4.67% (39 cases) and 2.16% (18 cases), respectively. Moreover, 47.54% (397 cases) of the anomalies were shown to be potentially serious, and an RCA arising from the left sinus of Valsalva (LSV) was the most common subtype (39.28%, 328 cases). Although anomalous origin of coronary arteries is not quite common, more clinical attention should be paid to this condition due to the potential risk of serious sequelae.     

Combined anatomical and functional imaging using coronary CT angiography and myocardial perfusion SPECT in symptomatic adults with abnormal origin of a coronary artery

There has been a lack of standardized workup guidelines for patients with congenital abnormal origin of a coronary artery from the opposite sinus (ACAOS). We aimed to evaluate the use of cardiac hybrid imaging using multi-detector row CT (MDCT) for coronary CT angiography (Coronary CTA) and stress-rest myocardial perfusion SPECT (MPS) for comprehensive diagnosis of symptomatic adult patients with ACAOS. Seventeen symptomatic patients (12 men; 54?±?13?years) presenting with ACAOS underwent coronary CTA and MPS. Imaging data were analyzed by conventional means, and with additional use of 3D image fusion to allocate stress induced perfusion defects (PD) to their supplying coronary arteries. An anomalous RCA arose from the left anterior sinus in eight patients, an abnormal origin from the right sinus was detected in nine patients (5 left coronary arteries, LCA and 4 LCx). Five of the 17 patients (29%) demonstrated a reversible PD in MPS. There was no correlation between the anatomical variants of ACAOS and the presence of myocardial ischemia. Image fusion enabled the allocation of reversible PD to the anomalous vessel in three patients (two cases in the RCA and the other in the LCA territory); PD in two patients were allocated to the territory of artery giving rise to the anomalies, rather than the anomalies themselves. In a small cohort of adult symptomatic patients with ACAOS anomaly there was no relation found between the specific anatomical variant and the appearance of stress induced myocardial ischemia using cardiac hybrid imaging.     

Primary Percutaneous Coronary Intervention of Anomalous Origin of Right Coronary Artery Above the Left Sinus of Valsalva in a Case with Acute Myocardial Infarction

Anomalous origin of the right coronary artery from the ascending aorta above the left sinus of Valsalva is exceedingly rare. We presented a case with anomalous origin of the RCA above the left sinus of Valsalva with inferior wall myocardial infarction and successful primary percutaneous coronary intervention to this artery which is the first report in the literature.     

屏气法三维磁共振冠状动脉血管造影诊断先天性冠状动脉起源畸形

目的探讨屏气法三维磁共振冠状动脉造影(3D MRCA)显示畸形冠状动脉与主动脉根部、右心室流出道关系的可行性及价值.方法 5名临床拟诊患者、1例志愿者接受MRCA检查,以屏气法三维稳态进动快速成像(3D true-FISP)梯度回波序列采集图像,获得左、右冠状动脉图像,分析畸形冠状动脉近段与冠状动脉窦(Valsalva窦)、右心室流出道的位置关系.结果 6例MRCA均明确诊断先天性冠状动脉起源畸形,畸形血管近段均走行于主动脉根部与右心室流出道之间.结论屏气法3D MRCA可明确诊断先天性冠状动脉起源畸形,显示畸形冠状动脉近段的走行路经,是一种可行的影像诊断方法.     

CTA诊断冠状动脉异常起源肺动脉

目的 探讨冠状动脉（简称冠脉）异常起源肺动脉（ACAPA）的CTA图像特征。方法 回顾性分析本院收治的24例ACAPA的患者资料,分析其CTA表现,并与手术结果对照。结果 24例患者中,发生于左冠脉20例（20/24,83.33%）、右冠脉1例（1/24,4.17%）、前降支1例（1/24,4.17%）、回旋支2例（2/24,8.33%）。冠脉异常起源部位：起源于肺动脉窦或肺动脉主干后壁11例（11/24,45.83%）、左壁7例（7/24,29.17%）、右壁4例（7/24,16.67%）,起源于左肺动脉2例（2/24,8.33%）。侧支循环：婴儿型5例,冠脉间未见侧支血管;成人型19例,其中左/右冠脉异常起源16例,前降支异常起源1例,回旋支异常起源2例。合并双前降支和冠脉在升主动脉壁内走行各1例。外科手术19例。术后CTA复查5例,1例人工管道与回旋支吻合口局限性狭窄,1例右心室流出道再狭窄,1例冠脉假性动脉瘤。结论 CTA可清晰显示冠脉异常起源部位、与升主动脉的距离、侧支血管、合并其他冠脉畸形,有助于术前制定手术方式及术后随访。     

64层螺旋CT冠状动脉血管成像诊断冠状动脉变异的价值

目的：评价64层螺旋CT冠状动脉血管成像（CTA）在诊断各种类型冠状动脉变异中的价值和临床应用。方法：回顾性分析617例行冠状动脉CTA检测患者的冠状动脉变异检出率，并根据CT结果对冠状动脉变异进行分类。结果：617例冠状动脉CTA受检者中，共检出冠状动脉变异78例（12．64％，78／617），其中右冠状动脉起自主动脉左冠状窦者9例，左冠状动脉起自主动脉右冠状窦者2例，右冠状动脉开口高位者2例，多开口变异者2例（并行左主干），心肌桥者59例．前降支．肺动脉瘘者2例，左右冠状动脉一肺动脉瘘者l例，右冠状动脉一左室瘘合并右冠状动脉瘤者1例。结论：冠状动脉CTA能准确评估冠状动脉变异，并可清晰显示各类病变细节，可作为无创性诊断冠状动脉变异的首选方法。     

Anomalous origin of the left circumflex coronary artery from the pulmonary artery. A very rare congenital anomaly in an adult patient diagnosed by cardiovascular magnetic resonance

Here we report for the first time on the diagnostic potential of cardiovascular magnetic resonance (CMR) to delineate the proximal course of an anomalous left circumflex coronary artery (LCX) originating from the right pulmonary artery in an adult patient with no other form of congenital heart disease. The patient was referred to our institution due to exertional chest discomfort. X-Ray coronary angiography showed a normal left anterior descending coronary artery (LAD) and right coronary artery (RCA), while the LCX was filled retrograde by collateral flow through the LAD and the RCA. The origin of the LCX was postulated to be the pulmonary artery, but the exact origin of the anomalous artery could not be depicted on conventional angiograms. CMR provided the unambiguous depiction of the origin of the anomalous LCX from the right pulmonary artery and the delineation of its proximal course in this case of a very rare coronary anomaly in adults.     

Anomalous origin of the three coronary arteries from the right aortic sinus Valsalva: Role of MDCT coronary angiography

Background Monocuspal origin of all three coronary arteries through separate ostia from the right aortic sinus (RCS) is a rare occurrence. To date, the use of multidetector computed tomography (MDCT) for imaging of congenitally abnormal coronary arteries has been discussed only in few individual case reports.Objective To describe the role of MDCT coronary angiography in the evaluation of two rare cases of monocuspal origin of all three coronary from RCS.Patients and methods We had a retrospective review of clinical information and imaging studies for two patients presented with chest pain. Both patients underwent conventional coronary angiography followed by noninvasive imaging with MDCT.Results Both patients had anomalous origin of the all three coronary arteries from the RCS. In one case the LAD took an intramural course in between the aorta and the right ventricular outflow tract (RVOT) while it passed anterior to the RVOT in the other patient. In the first patient, there was also associated coronary fistula to the right ventricle along with right coronary artery (RCA) and left anterior descending coronary artery (LAD) narrowing. Both the stenosed segments were successfully stented and were demonstrated to be patent in the subsequent MDCT.Conclusion Monocuspal origin of all three coronary artery from the RCS is a rare anomaly, can be reliably diagnosed by MDCT. CT angiogram is a convenient complementary tool for the coronary arteriography