成年人冠状动脉造影先天性变异分析

目的 :探讨成年人先天性冠状动脉变异 (畸形 )的检出频度。　　方法 :回顾性研究总结 4173例患者的冠状动脉造影资料 ,准确判定各种先天性冠状动脉变异。　　结果 :1冠状动脉造影 4173例中检出冠状动脉开口起源异常 5 0例 ,检出率为 1.2 % ,其中各种右冠状动脉起源异常 42例 ,占 84.0 % ,左冠状动脉起源异常 7例 ,占 14.0 % ,左、右冠状动脉开口起源均异常 1例 ,占 2 .0 % ;2检出各种类型冠状动脉分支起源异常 15例 ,检出率为 0 .4% ;3检出各种类型冠状动脉瘘 2 8例 ,检出率为 0 .7% ,其中 18例(6 4.3% )为冠状动脉—肺动脉瘘 ;4其它少见冠状动脉变异 2例。　　结论 :成年人先天性冠状动脉变异的临床症状和体征多不典型或缺如 ,通常在心导管检查中被偶然发现 ,冠状动脉造影是确诊各种类型冠状动脉变异最重要的检查方法。     

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。     

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。     

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:     

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.     

右冠状动脉缺如左冠状动脉双支病变PCI术1例

冠状动脉解剖变异临床上较为常见,冠状动脉变异特别是起源变异的发生概率为1%~2%,其中右冠状动脉起源变异占80%。右冠状动脉常见变异为开口位置异常,而先天性缺如却少见,有人认为右冠状动脉先天性缺如与胚胎时期冠状动脉异常发育或未发育完全有关。本文就1例右冠状动脉缺如并左冠状动脉双支病变行经皮冠状动脉介入治疗(PCI)术总结分析如下:     

冠心病右冠状动脉病变的临床分析

目的:分析我科冠心病患者临床症状和冠脉造影资料,总结右冠脉狭窄的临床特点。方法:统计我科2002至2006所有行冠脉造影并确诊冠心病患者的冠脉狭窄资料,将其分为单支血管病变组和多支病变组,就右冠和左冠脉病变的特点作对比分析。结果:多支病变组右冠脉和左冠脉狭窄发病率相差不明显(P>0.05),而单支病变组右冠脉狭窄发病率明显低于左冠脉(P<0.001)。结论:右冠脉狭窄病变发病率比较低。     

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.     

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.     

Anomalous origin of the right coronary artery from the left coronary sinus is associated with early development of coronary artery disease

BACKGROUND: Anomalous origin of the right coronary artery (RCA) from the left coronary sinus can cause sudden cardiac death. Whether this unique anatomical defect also predisposes to early development of coronary artery disease (CAD) remains uncertain. METHODS: Demography, cardiovascular risk factor profiles and coronary angiograms were reviewed in 1,532 consecutive patients over the past 3 years. RESULTS: Thirteen patients (0.8%) had anomalous RCA from the left coronary sinus, while the rest had normal origin from the right coronary sinus. CAD was found in 9/13 anomalous RCA patients (group A) and in 795/1,519 patients with normal RCA origin (group B). There were no differences in the distributions of age, sex or cardiovascular risk factors between the two groups. The distribution of critical lesions among the 3 major coronary arteries showed no significant differences either. However, among the patients with RCA involvement, the anomalous RCA group was significantly younger (54.8 +/- 4.8 years versus 64.9 +/- 10.1 years; p = 0.022). CONCLUSION: The anomalous RCA from left coronary sinus is associated with early development of CAD. The affected patients are 10 years younger.     

Primary congenital anomalies of the coronary arteries: a coronary arteriographic study in Western Turkey

Coronary artery anomalies are found in 0.6% to 1.5% of coronary angiograms. Angiographic recognition of these vessels is important because of their clinical significance and importance in patients undergoing coronary angioplasty or cardiac surgery. We reviewed the database of the Cardiac Catheterization Laboratory of Uludag Medical University in Bursa, Turkey. All patients who were subjected to coronary angiography from 1994 to 2001 were included. The study included 12,059 patients who underwent diagnostic coronary arteriography during the 8 year period. One hundred patients had primary congenital coronary anomalies. Ninty-five (95%) of the patients had anomalies of origin and distribution while five (5%) had coronary artery fistulae. The left main coronary artery (LMCA) was the most common anomalous vessel involved (forty-eight (48%) of the patients). An LMCA distribution anomaly was observed in these 48 patients. An anomalous right coronary artery (RCA) was the second most common anomaly, seen in twenty-two (22%) of the patients. An anomalous circumflex artery (Cx) was the third most common anomaly, seen in seventeen. Five patients had a coronary artery fistulae. The fistulae in our series were small without significant shunt circulation. Primary congenital coronary anomalies are isolated lesions and generally have no relation with other congenital heart diseases. They do not appear to be associated with an increased risk for development of coronary atherosclerosis. Angiographic recognition of these vessels is important because of their clinical significance and importance in patients undergoing coronary angioplasty or cardiac surgery.     

Anomalous left anterior descending, absent circumflex and unusual dominant course of right coronary artery: a case report--R1

A 40-years-old female presented with atypical chest pain. Selective coronary angiography revealed separate osteal origin of anomalous left anterior descending (LAD) and normal origin of right coronary artery (RCA) from right anterior coronary sinus. LAD had a septal course. Left circumflex (LCx) was absent. RCA, a dominant vessel, continued beyond the crux, along the entire length of atrioventricular groove as circumflex artery. There was no myocardial ischemia on stress thallium. As per our knowledge, this type of combination of anatomical variation of coronary circulation has not been described in the literature.