冠状动脉起源于肺动脉的影像学研究

目的 探讨冠状动脉(简称冠脉)起源于肺动脉(ACAPA)影像学诊断方法的价值。方法 回顾性分析11例ACAPA的影像学表现。11例均行X线胸片、超声心动图(Echo)和心血管造影检查，其中1例行电子束CT(EBCT)检查。结果 10例为左冠脉起源于肺动脉，1例为右冠脉起源于肺动脉。11例胸片均未确诊，Echo诊断3例，EBCT诊断1例。心血管造影全部诊断正确，其中左冠脉异常起源者左冠脉均发自主肺动脉后窦或后壁，通过扩张的右冠脉藉侧支逆行充盈；右冠脉异常起源者右冠脉从主肺动脉右窦发出。手术与造影所见相同。3例前乳头肌缺血性纤维化，二尖瓣环扩大，前叶脱垂致二尖瓣关闭不全。结论 X线胸片诊断受限，Echo简便、无创，但操作技术及认知水平有待提高。心血管造影仍是术前确诊的“金标准”。     

The cristal (right superior septal) coronary artery and its relationship to anomalous left coronary origin

The cristal artery is an occasional finding, being visible in around 3% of coronary angiograms, arising from the proximal right coronary artery (RCA) and passing downwards and forwards through the muscle of the crista superventricularis. It supplies a variable volume of the superior interventricular septum, and can contribute to collateralization of the other septal vessels. When part or all of the left coronary artery (LCA) arises anomalously from the right coronary sinus, its passage to the left may be in the same pathway as a cristal artery, bearing a tell-tale septal vessel arising from its proximal segment. This helps to differentiate it from one that has a higher pathway, running between the great vessels, and which may have a greater correlation with sudden cardiac death.     

Sudden infant death with anomalous origin of the left coronary artery from the pulmonary artery

Autopsy of a 2-month-old boy revealed an anomalous origin of the left coronary artery from the pulmonary trunk. The endomyocardial fibrosis associated with myocardial ischemia was noted in the left ventricular wall of the enlarged heart. Death was attributed to silent heart failure due to the anomalous left coronary artery. Significant clinical symptoms are generally observed in patients with such anomalies, however, they might cause sudden death in childhood.     

Shepherd's crook configuration of right coronary artery and anomalous origin of left circumflex artery from right coronary cusp in a middle-aged man—A case report

Shepherd''s crook configuration of the right coronary artery is a course anomaly where the ostium is oriented superiorly with the proximal artery taking an upward turn before resuming its regular path. Although it is classified as an unimportant hemodynamic variation, it is relevant in the context of coronary artery disease due to the technical issues it causes when being treated. The anomalous origin of the left circumflex artery arising as a separate branch from the right coronary cusp is a rare variant and its significance lies in its association with sudden arrhythmia, syncope, and sudden cardiac death. Here we report a case of a 58-year-old male patient with an anomalous course of the right coronary artery consistent with Shepherd''s crook configuration and anomalous origin of the left circumflex artery from the right coronary cusp.     

The diagnosis and assessment of an adult with anomalous origin of the left coronary artery from the pulmonary artery

Anomalous origin of the left coronary artery from the pulmonary artery (the Bland-White-Garland syndrome) is a rare congenital cardiac defect which may present for the first time in adulthood. The recognition of this disorder, which produces widespread left ventricular ischaemia and the risk of sudden death, myocardial infarction and congestive heart failure, is important as the prognosis can be improved by surgical intervention. Thallium-201 scintigraphy has a useful role in demonstrating the widespread nature of the ischaemia of the left ventricle, whilst the diagnosis is confirmed at cardiac catheterisation.     

单侧肺动脉异常起源于主动脉的影像学诊断

目的 评价单侧肺动脉异常起源于主动脉的影像学诊断。方法 回顾性分析了９例单侧肺动脉异常起地主动脉患者的临床表现、Ｘ线征象、诊断方法和手术治疗资料,所有病人均做了Ｘ线平片、彩色多普勒超声心动图及心血管造影检查。结果 ９例Ｘ线平片均有肺血增多,心脏增大。多普勒超声心动图检查６例漏诊,３例术前确诊。９例心血管造影均清楚显示该症的解剖畸形。结论心血管造影是诊断单侧肺动脉异常起源于主动脉最可靠的手段。     

Unique anomalous origin of the left anterior cerebral artery

We present the case of an anomalous origin of the left anterior cerebral artery (ACA) from the supraclinoid segment of the right internal carotid artery. Because of improved imaging quality, anomalies of the ACA-anterior communicating artery (AComA) complex are increasingly recognized on transaxial images. Although most of these anomalies are incidental findings of little clinical significance, some ACA-AComA complex anomalies are clinically significant. Recognition of these anomalies may be instrumental in developing a differential diagnosis or for improved surgical planning.     

Unusual origin and course of the first septal branch of the left coronary artery: Angiographic recognition

The anatomical variants of the origin and course of the first septal branch (S1) of the left coronary artery system have received little attention in the literature dealing with coronary angiography. We describe here the angiographic features of the ectopic origin of S1 from epicardial branches of the left coronary artery other than the left anterior descending artery as observed in 8 cases from a series of 700 consecutive patients (1.1%). The S1 originated from the left main coronary artery in 1 case, from a diagonal branch in 4, and from an intermediate branch in 3 cases. Previous reported cases are reviewed. Because the S1 may supply up to 15% of the blood to the myocardium, the recognition of this variable origin may have clinical implications and has to be considered as a part of the complete evaluation of coronary arteriograms of patients referred for coronary artery revascularization.     

左冠状动脉起源于肺动脉的超声心动图诊断价值及漏诊分析

目的:探讨多普勒超声心动图对左冠状动脉异常起源于肺动脉(ALCAPA)的诊断价值,分析超声心动图漏诊的原因,旨在提高超声对ALCAPA诊断的准确率.方法:本文总结了17例经心血管造影及磁共振检查确诊为ALCAPA的患儿,并与其超声心动图检测结果进行对照.结果:17例患儿中,超声诊断符合11例(占64.7%),超声误诊6例(占35.3%);其中3例超声诊断为扩张型心肌病,2例超声诊断为左冠状动脉肺动脉瘘,1例诊断为二尖瓣中度反流.结论:超声心动图能较准确地诊断ALCAPA,但易漏误诊.左心室明显增大伴室间隔内丰富侧支血流信号者,应高度怀疑ALCAPA;若左冠状动脉显示不清,应行心血管造影或核磁共振检查.     

Use of navigator-echo-gated MRI to diagnose a coronary shunt involving an anomalous origin of the right coronary artery from the pulmonary artery.

Origin of the right coronary artery from the main pulmonary artery is an anomaly that can cause formation of a left-to-right coronary shunt, leading to myocardial ischemia and early onset of congestive heart failure. We describe a case in which magnetic resonance imaging was able to show the anomalous origin of the right coronary artery, and magnetic resonance phase velocity mapping was able to demonstrate the presence of a left-to-right shunt through the coronary artery by showing retrograde flow in the right coronary artery.     

Unexpected sudden death resulting from anomalous origin of the left coronary artery from the right sinus of Valsalva

Sudden death accounts for a large proportion of nontraumatic deaths. These deaths represent a considerable financial and emotional burden to the community, especially when they occur in younger age groups. One case of a 14-year-old man, who suddenly collapsed and died while playing soccer at school is shown. A complete medicolegal autopsy was performed, including toxicological analysis and microscopic examinations. During the necropsy, an study anomalous origin of the left coronary artery originating from the right Valsalva's sinus was noted. The present article discusses the possible relationship between this finding and sudden death.     

Isotopic findings in anomalous origin of the left coronary artery from the pulmonary artery: report of an adult case

Anomalous origin of the left coronary artery from the main pulmonary trunk results in myocardial ischemia or infarction, and may be a cause of death in the first months of life. Some patients, however, develop satisfactory coronary collateral circulation and remain asymptomatic into adulthood. In these patients, myocardial perfusion and left ventricular function are not well understood. We report the case of a 17-yr-old female patient, suffering from anomalous origin of the left coronary artery from the main pulmonary trunk, who underwent reimplantation of the left coronary artery to the aorta. The preoperative permanent 201Tl defect of the left antero-lateral ventricular wall and the abnormal regional wall motion induced by stress exercise testing were fully reversed after the operation.