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。     

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。     

冠状动脉造影明确冠状动脉起源异常的发生率及分类

目的探讨冠状动脉异常起源及分类。方法回顾性分析21 215例吉林大学白求恩第一医院行冠状动脉造影检查患者的冠状动脉造影影像。结果在21 215例患者中,冠状动脉起源异常者为81例,发生率为0.4%。右冠状动脉起源异常共70例,占冠状动脉起源异常总数86.4%,其中62例(76.5%)为右冠状动脉开口于左冠状窦,4例(4.9%)右冠状动脉开口于无冠状窦,1例(1.2%)为右冠状动脉开口于左前降支,1例(1.2%)为右冠状动脉开口于升主动脉,2例(2.5%)为右冠状动脉开口于冠状窦上方。左冠状动脉起源异常共11例,占冠状动脉起源异常总数13.6%,其中3例(3.7%)为左冠状动脉开口于右冠状窦;3例(3.7%)为左回旋支开口于右冠状动脉;1例(1.2%)为左回旋支开口于右冠状窦下方;1例(1.2%)为无左主干,左前降支与左回旋支开口于左冠状窦;2例(2.5%)为无左主干,左前降支与左回旋支开口于主动脉;1例(1.2%)为无左主干,左前降支开口于左冠状窦、左回旋支开口于右冠状窦。结论在冠状动脉起源异常中,右冠状动脉起源异常较常见,其中右冠状动脉开口于左冠状窦最为常见。在冠状动脉造影时,起源异常的冠状动脉其走行也可发生变化。对于冠状动脉起源异常且走行在主-肺动脉之间的冠状动脉异常者,可考虑行手术治疗。     

左冠状动脉开口于右冠状动脉窦(附2例病例)

<正>左冠状动脉开口于右冠状动脉窦是冠状动脉起源异常的类型之一。冠状动脉起源异常中,只有不到1/3的患者为左冠状动脉起源异常,而左冠状动脉开口于右冠状动脉窦更为少见。本文就冠状动脉造影检查发现的2例左冠状动脉起源于右冠状动脉窦(即左右冠状动脉共开口)病例报道如下:     

老年患者冠脉起源异常合并急性心肌梗死2例

<正>冠状动脉起源异常在总人群的发生率为0.6%¹.3%,包括左冠状动脉(LCA)起源于肺动脉,LCA开口于右冠状动脉窦,右冠状动脉(RCA)开口于左冠状动脉窦,回旋支起源于右冠状动脉窦等。左、右共干罕有文献报道,发生率约为人群的0.024%1.3%,包括左冠状动脉(LCA)起源于肺动脉,LCA开口于右冠状动脉窦,右冠状动脉(RCA)开口于左冠状动脉窦,回旋支起源于右冠状动脉窦等。左、右共干罕有文献报道,发生率约为人群的0.024%⁰.044%。本文报道罹患此种畸形同时合并急性心肌梗死2例,冠脉造影(CAG)均证实患者冠脉起源异常,并成功行急诊经皮冠状动脉溶栓治疗术(PCI)。     

儿童冠状动脉异常主动脉起源的超声评估分析

目的 探究经胸超声心动图诊断冠状动脉异常主动脉起源的超声影像学特点及方法，提高对儿童冠状动脉异常主动脉起源的认识和早期诊断。方法 回顾性分析2014年1月到2020年12月首都儿科研究所附属儿童医院心功能室诊断的60例冠状动脉异常起源主动脉患儿，分析患儿的临床症状、心电图及超声心动图检查结果。结果 冠状动脉异常起源总检出率为0.2%。其中男40例，女20例，年龄(49.1±39.4)月，体重(22.7±15.9)kg，因可疑川崎病经冠状动脉检查者27例，心律失常4例，晕厥2例，胸痛1例，余病例均为偶然发现。所有病例中右冠状动脉起源于左冠窦有54例(90.0%)，右冠状动脉起源于左右冠窦交界处为4例(6.6%)，右冠状动脉起源于左主干1例(1.7%)，左冠状动脉起源于右冠窦1例(1.7%)。其中1例左冠状动脉异常起源于右冠窦患儿，有晕厥病史并伴有左心增大及心功能下降；另1例为右冠状动脉异常起源于左冠窦伴开口狭窄，后行手术治疗。结论 经胸超声心动图可筛查出冠状动脉异常主动脉起源。超声医师需认识到该病可能引起的恶性后果，建议在婴幼儿期普及经胸超声冠状动脉检查，尽早诊断出冠状动脉异常主动脉起源。     

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病例特点及超声评估分析

目的：分析成人冠状动脉异常起源的临床表现及超声心动图特征，探讨经胸超声心动图（transthoracic echocardiography,TTE）诊断正确率及漏误诊原因。方法：回顾性分析安贞医院2007年1月至2020年12月经冠状动脉CT血管造影或冠状动脉造影明确诊断为单纯冠状动脉异常起源患者88例，平均年龄（46.7±15.5）岁，男性51例，女性37例。分析成人冠状动脉异常起源的分型、临床表现、TTE特征及超声诊断漏误诊原因。结果：成人冠状动脉异常起源超声诊断正确率：TTE对冠状动脉异常起源于肺动脉（anomalous coronary artery originated from pulmonary artery,ACAPA）的诊断正确性最高，约76.9%(20/26)；冠状动脉异常起源于主动脉（anomalous origin of coronary artery from aorta,AAOCA)的诊断正确率仅为4.8%(3/62),3例均为左冠状脉起自右冠窦。成人冠状动脉异常起源超声特征：AAOCA的超声表现为：非正常窦部位可见一血管开口，开口受压病例CDFI可见异常起...     

左冠状动脉回旋支起源于右冠窦3例

正冠状动脉起源异常(AOCA)通常指左、右冠状动脉(右冠)未能正常从相对应的主动脉窦起源,而是异常开口于对侧主动脉窦或无冠窦、升主动脉甚至是肺动脉,并伴有冠状动脉(冠脉)走行异常。目前认为是胚胎期冠脉异常发育或未发育完全造成的[1]。本文报道了3例冠脉左回旋支起源于右冠窦的病例,旨在帮助临床医师提高对该类畸形的认识,避免漏诊,现总结如下。1病例病例1患者男性,48岁,主因"间断心悸9 d"入院。患者于9 d前无明显诱因出现心悸,伴头晕、恶心、呕吐,无明显胸闷、胸痛,于当地医院行冠脉CTA检查,可见第     

SAL指引导管在起源异常的右冠状动脉行经皮冠状动脉介入治疗中的应用

目的探讨SAL指引导管在起源异常的右冠状动脉行经皮冠状动脉介入治疗(PCI)中应用的安全性及有效性。方法回顾性分析2012年1月至2016年3月于淮北矿工总医院住院的22例右冠状动脉开口异常患者的介入诊疗资料。所有患者均常规采用经右侧桡动脉入径,选择JR或Tiger指引导管行右冠状动脉造影,若造影提示右冠状动脉开口异常并有PCI适应证,或经反复尝试造影导管无法到达右冠状动脉开口时,改用SAL指引导管造影。观察患者术中及术后血管痉挛、慢血流、无复流、开口撕裂、夹层、急性闭塞及主要不良心血管事件的发生情况。结果 22例患者中开口位于主动脉壁7例(31.8%)、左冠状窦7例(31.8%)、左回旋支2例(9.1%)及右冠状窦上方6例(27.3%)。10例(45.5%)患者经JR或Tiger指引导管完成冠状动脉造影,后有2例更换SAL指引导管完成PCI术;12例(54.5%)患者经JR或Tiger指引导管反复尝试均无法完成冠状动脉造影,更换SAL指引导管后11例造影成功,其中3例行PCI术。1例患者应用JR、Tiger及SAL指引导管反复尝试仍未能完成冠状动脉造影,后经冠状动脉CT血管造影证实开口于升主动脉侧壁。术中所有患者均未见血管痉挛、慢血流、无复流、开口撕裂、夹层、急性闭塞等并发症发生。术后随访6~12个月,未见心源性死亡、急性心肌梗死及靶血管再次血运重建等主要不良心血管事件发生。结论对于起源异常的右冠状动脉采用SAL指引导管行PCI,成功率高,且安全有效。     

The primary anomalies of coronary artery origin and course: A coronary angiographic analysis of 16,573 patients

BACKGROUND/OBJECTIVES:

Coronary artery anomalies are present at birth, but relatively few are symptomatic. The majority are discovered incidentally. In the present study, coronary angiograms performed in the authors’ centre (Ondokuz Mayis University Hospital, Samsun, Turkey) were analyzed to determine the prevalence and types of coronary artery origin and course anomalies.

METHODS:

Coronary angiographic data of 16,573 patients were analyzed. Anomalous origins and courses of coronary arteries were assessed.

RESULTS:

Anomalous coronary arteries were detected in 48 (0.29%) of 16,573 patients. The origin of the circumflex (Cx) artery from the right coronary artery (RCA) or right sinus of Valsalva was the most common anomaly (28 patients [58.3%]). An anomalous RCA originating from the left anterior descending artery (LAD) or Cx artery was observed in six patients (12.5%). The left coronary artery originated from the right sinus of Valsalva in five patients, and the LAD originated from the RCA or the right sinus of Valsalva in five patients. The RCA originated from the left sinus of Valsalva in three patients and from an ectopic ostium in the ascending aorta in one patient.

CONCLUSIONS:

The most frequent anomaly observed in the present study was related to the Cx artery, which is consistent with previous reports. Although coronary artery anomalies are rare, they may cause difficulties during coronary interventions or cardiac surgery and may occasionally result in sudden cardiac death. Therefore, the recognition and diagnosis of these anomalies is important and requires specialization in coronary angiographic techniques and other imaging modalities.     

成人冠状动脉造影中动脉起源异常分析

目的 利用较大样本冠状动脉造影资料分析国人先天性冠状动脉开口起源异常的检出频度。方法 回顾性研究分析1988年8月至2003年12月阜外医院22 636例成年人冠状动脉造影资料,将检出的先天性冠状动脉开口起源异常进行总结和分类,并与国内外文献进行比较。结果22 636例冠状动脉造影中检出冠状动脉开口起源异常234例,总检出率为1.03％。其中右冠状动脉起源异常138例(58.97％),是涉及起源异常最多见的冠状动脉;左冠状动脉起源异常89例(38.03％);左、右冠状动脉开口起源均异常1例(O.43％);单一冠状动脉6例(2.57％)。22 636例冠状动脉造影中冠状动脉分布优势类型:右优势型19 940例(88.09％),均衡型1500例(6.63%),左优势型1196例(5.28％)。结论 这是迄今为止收入样本量最大的有关国人冠状动脉起源异常的造影资料分析。其先天性冠状动脉起源异常检出率与国外文献报道相符,但类型特点有所不同。     

Anomalous origin of coronary artery from the opposite aortic sinus of Valsalva-a single center experience with a therapeutic conundrum

Background: Coronary artery anomalies are rare congenital abnormalities, most often found incidentally on conventional coronary angiography and CT angiography (CTA). CTA better delineates the origin and course of anomalous coronaries. Anomalous origin of coronary artery from the opposite aortic sinus of Valsalva (ACAOS) has a prevalence of 1% with a very few having an interarterial (malignant) course. There is limited literature, especially in the Indian population, dealing with this topic.Methods: In this retrospective observational study, angiographic data of 8500 consecutive patients from June 2011 to December 2019 at a large tertiary care hospital in western India was analyzed. Patients diagnosed with ACAOS underwent CTA for delineation of the exact anatomy. Those with a non-malignant course with evidence of ischemia clinically or on stress myocardial perfusion imaging (MPI), underwent PCI. Others with a non-malignant course were medically managed. Patients with malignant (interarterial) course were revascularized by coronary artery bypass graft (CABG) surgery in case of LCA involvement or positive MPI test. Asymptomatic patients with negative MPI were managed medically. Clinical follow-up over 12 months of patients undergoing PCI and those with a malignant course showed no major adverse cardiovascular events (MACE).Results: Of the 8500 patients studied, 74 (0.87%) had ACAOS. Of these, 51 (68.9%) patients had anomalous origin of right coronary artery (RCA) from the left aortic sinus, 21 (28.4%) had anomalous origin of the circumflex artery (Cx) from the right aortic sinus and two patients (2.7%) had an anomalous origin of the left main coronary artery (LCA) from the right aortic sinus. Interarterial course was found in five (6.7%) patients. Of these, four patients underwent CABG-one asymptomatic patient with LCA from right aortic sinus and three with positive MPI in anomalous RCA. All five patients with malignant course and ten patients who underwent PCI were free of MACE over 12 months’ clinical follow up.Conclusions: ACAOS is a rare anomaly and if interarterial course is excluded, then PCI is feasible in selected cases with significant stenosis. Patients with malignant course with inducible ischemia or LCA involvement should undergo surgical revascularisation.     

右冠状动脉起源异常经桡动脉途径行冠状动脉介入治疗：单中心经验

目的回顾性分析右冠状动脉异常起源于主动脉患者的临床特点、解剖分布规律及冠状动脉介入诊疗过程中的导管选择及技术要点。方法 2009年10月至2014年5月厦门市心脏中心发现右冠状动脉起源异常患者共36例,其中19例行经皮冠状动脉介入治疗（PCI）。36例患者均经桡动脉途径,分析其异常起源情况、术中造影导管选择及技术要点;列举19例行PCI患者的右冠状动脉解剖特点、造影及指引导管选择和术中对比剂用量。结果除1例因头臂干过于迂曲外,其余35例（97.2%,35/36）患者均成功完成选择性冠状动脉造影,19例（52.8%,19/36）行PCI术,除1例慢性完全闭塞病变（CTO）经历二次手术外,余均首次手术成功。35例患者中高位升主动脉偏右侧起源2例[5.7%（2/35,A型],高位升主动脉偏左侧起源3例[8.6%（3/35）,B型],左主干至左窦中线间起源14例[40.0%（14/35）,C型],左冠状窦中线向右冠状窦移行区域起源16例[45.7%（16/35）,D型],其中90%（27/30）C及D型患者使用Tiger造影导管。19例行PCI的患者中A型2例（10.5%,2/19）、B型3例（15.7%,3/19）、C型7例（36.8%,7/19）、D型7例（36.8%,7/19）。A型2例患者使用IL 3.5及MPD指引导管,B型3例使用EBU 3.5及EBU 3.0导管,C型7例及D型7例中分别有6例使用IL 3.5指引导管完成PCI。结论熟悉右冠状动脉异常起源于主动脉的解剖分布规律和相对应的造影及指引导管,有助于提高经桡动脉途径处理该类病变的成功率。     

冠状动脉起源异常的检出率与冠状动脉狭窄

目的　评价国人冠状动脉(冠脉)起源异常的冠脉造影检出率,并探讨其与冠脉狭窄之间的关系。方法　回顾性分析2001年1月至2004年6月在我院接受选择性冠脉造影的患者,观察并记录冠脉起源异常的检出频度和类型,以及合并冠脉狭窄的情况。结果　4094例患者中,共检出冠脉起源异常者32例,检出率为0 78%,其中右冠脉异常起源最为多见,占总数的65 6%;合并冠脉狭窄者共11例(占34 3% ), 其中仅5例(占15 6% )累及起源异常的冠脉,且无1例冠脉狭窄单独累及起源异常的冠脉。结论　国人冠脉起源异常的检出率与国外文献报道结果相似,其中以右冠脉起源异常最为多见,冠脉起源异常与冠脉狭窄不具有相关性。     

Anomalous origin of the right coronary high above the left sinus of Valsalva

Anomalous origin of the right coronary artery from the ascending aorta above the left sinus of Valsalva is exceedingly rare and previously has been reported to be associated with congenital aortic valve disease. We report a case of the right coronary artery arising from the mid ascending aorta, high above the left sinus, with a clinically and angiographically normal aortic valve.     

Utility of three-dimensional volume rendering images using electron-beam computed tomography to evaluate possible causes of ischemia from an anomalous origin of the right coronary artery from the left sinus of valsalva.

The present study evaluated the usefulness of 3-dimensional volume rendering (VR) images using electron-beam computed tomography (EBCT) in determining the possible causes of ischemia resulting from the anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva, which coursed between the ascending aorta and pulmonary trunk. Such anomalies could cause ischemia or sudden death without obstructive coronary artery disease. The suggested mechanism is either compression causing closure of the slit-like orifice of the anomalous artery as the aorta dilates with exertion or compression of the anomalous artery by the aorta and pulmonary trunk as it courses between these 2 arteries, which dilate with exercise. A 17-year-old male underwent EBCT coupled with a 100-ml intravenous injection of iodinated contrast medium. Data were reconstructed into 3-dimensional images through VR to evaluate the shape of the orifice and the spatial relationship of the RCA, ascending aorta and pulmonary trunk. Perspective VR showed the shape of the orifice of the left main trunk, which was not slit-like, and cut-plane VR showed the spatial relationship of both the lumen and the surface of the RCA, ascending aorta and pulmonary trunk, providing information on whether the ascending aorta or pulmonary trunk would compress the RCA and cause ischemia.     

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.