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。     

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。     

先天性冠状动脉畸形11例报告

报告经冠状动脉造影或手术证实的单纯性先天性冠状动脉畸形11例,约占同期580例冠状动脉造影的1.6％。本组冠状动脉畸形病变分两大类:①冠状动脉瘘8例,含右冠状动脉右室瘘6例;②冠状动脉起源异常3例。指出冠状动脉瘘需与其他先天性心脏病鉴别,心脏B超对诊断有一定的帮助,冠状动脉造影为确定诊断的重要手段;对大的冠状动脉瘘应及时手术治疗。     

先天性冠状动脉异常的诊治进展

先天性冠状动脉异常是一类罕见的畸形,主要包括冠状动脉及分支起源异常、单支冠状动脉及冠状动静脉瘘。临床上结合超声心动图、多层螺旋或电子束计算机断层扫描(MDCT或EBCT)、心血管核磁共振显像(MRI)和心血管造影能明确诊断。手术是冠状动脉起源异常的主要治疗方式且效果良好。介入治疗已广泛应用于冠状动静脉瘘的治疗,并逐渐用于其他冠脉畸形的治疗。     

先天性冠状动脉异常的诊治进展

先天性冠状动脉异常是一类罕见的畸形,主要包括冠状动脉及分支起源异常、单支冠状动脉及冠状动静脉瘘.临床上结合超声心动图、多层螺旋或电子束计算机断层扫描(MDCT或EBCT)、心血管核磁共振显像(MRI)和心血管造影能明确诊断.手术是冠状动脉起源异常的主要治疗方式且效果良好.介入治疗已广泛应用于冠状动静脉瘘的治疗,并逐渐用于其他冠脉畸形的治疗.     

右冠状动脉起源异常2例报告

先天性冠状动脉异常包括的范围较广但临床少见。笔者报告2例右冠状动脉异常起源的2例患者，并加以讨论。     

多层螺旋CT诊断成人先天性冠状动脉畸形的临床价值

目的分析多层螺旋CT诊断成人先天性冠状动脉畸形(CCA)的临床价值。方法回顾性分析300名行多层螺旋CT冠状动脉成像(MSCTA)的资料,探讨冠状动脉的起源、走行和终止情况,统计成人先天冠状动脉畸形(CCA)的发生率及CT表现。结果300例中,检出各类CCA共84例,检出率为28.0%,其中起源异常11例,检出率3.7%;冠状动脉结构异常71例,心肌桥(MB)67例,检出率为22.3%,回旋支发育异常4例,检出率1.3%;冠状动脉终止异常2例,均为冠状动脉瘘,检出率0.7%。结论MSCT能够准确地显示冠脉起源、结构和终止异常,对成人冠状动脉畸形的诊断和预后判断有重要的临床应用价值。     

先天性冠状动脉瘘的诊断及外科治疗

先天性冠状动脉瘘的诊断及外科治疗白求恩医科大学第一临床医学院心脏外科王勇，乔建华，佟力，付彤先天性冠状动脉瘘（ＣＣＡＦ）是一种罕见的先天性心血管畸形，占先天性心血管病的１／５００００。我科共收治３例。现将其临床诊断及外科治疗体会介绍如下：１临床资料本...     

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。     

超声心动图检查在先天性肺动脉异常起源中的应用效果

目的探讨超声心动图检查在先天性肺动脉异常起源中的应用效果。方法选取2014年8月—2017年7月陆军军医大学第二附属医院收治的先天性肺动脉异常起源患儿28例,均行超声心动图检查。观察所有患者行超声心动图检查的诊断符合率、误诊率,并观察所有患者的治疗情况。结果所有患者行超声心动图检查的诊断符合率为96.4%(27/28),误诊率为3.6%(1/28)。接受肺动脉矫治或移植术治疗患者10例(先天性单侧肺动脉缺如8例、单侧肺动脉起源异常1例、肺动脉吊带1例),暂未接受外科手术治疗患者13例(先天性单侧肺动脉缺如4例、单侧肺动脉起源异常6例、肺动脉吊带3例),放弃治疗患者5例(先天性单侧肺动脉缺如1例、单侧肺动脉起源异常2例、肺动脉吊带2例)。结论超声心动图检查在先天性肺动脉异常起源中的应用效果较好。     

Anomalies of left coronary artery origin affecting surgical repair of hypoplastic left heart syndrome and Shone complex

There has traditionally been less concern regarding coronary anomalies with left-sided congenital heart lesions such as hypoplastic left heart syndrome (HLHS) or Shone complex than with other lesions. However, coronary anomalies in this setting can profoundly affect surgical intervention, particularly when surgical repair involves the ascending aorta. We describe four patients with congenital left-sided heart lesions in which left coronary artery (LCA) anomalies substantially affected intervention and outcome. In the first two cases, the coronary anomalies were not identified prospectively and resulted in surgical injury directly to the coronary or to its surrounding region. In the latter two cases, successful identification of the coronary anomaly preoperatively allowed for modification of surgical technique and/or intervention. We conclude that detailed coronary artery assessment should be part of the routine echocardiographic evaluation of congenital left-sided heart lesions that require surgery.     

Coronary Artery Anatomy in Congenital Heart Disease

Expanded surgical options and improved outcomes for children born with structural heart defects have ushered a greater clinical interest in the normal and abnormal development of the coronary circulation. Anatomic variations of the coronary system may impact surgical candidacy or operative technique during neonatal life, while others may impact long‐term clinical management and planning for subsequent interventions. This review aims to characterize coronary artery anatomy in symptomatic congenital heart disease, emphasizing the clinical consequence of these variations and anomalies.     

Congenitally Corrected Transposition of the Great Arteries and Concomitant Coronary Artery and Valvular Disease in the Adult Patient

Congenitally corrected transposition of the great arteries (ccTGA) accounts for less that 1% of cardiac anomalies, and is defined as ventriculoarterial and atrioventricular (AV) discordance. The double discordant connection allows for survival with the right ventricle performing as the systemic ventricle, and the left ventricle as the pulmonary ventricle. We report a case of ccTGA in a 35-year-old male with situs inversus totalis status post repair of a ventricular septal defect (VSD) with a residual VSD, severe systemic AV valve regurgitation, and coronary artery disease who presented with chest pain. He subsequently underwent tricuspid valve replacement and VSD repair, followed by percutaneous coronary revascularization. This case highlights many important issues of adults with congenital cardiac disease, as well as the specific surgical management of anomalies associated with ccTGA. We review the literature and discuss the management of these complicated patients.     

Congenital coronary artery fistulas in adults: surgical treatment and outcome

BACKGROUND: Congenital coronary artery fistulas, a subgroup of anomalies of the coronary arteries, are an extremely rare cardiac defect. Most patients are asymptomatic, and if symptoms are presented, they depend on the underlying anatomy. Knowledge of those fistulas is important for prognosis and management. METHODS: Thirteen adult patients with congenital coronary fistulas (8 male, 5 female) were operated in our department during the last decade (1990-1999). Mean age was 61.5+/-10.8 years. Diagnosis was made by coronary angiography, and 15 congenital coronary artery fistulas were found. RESULTS: All patients were symptomatic with clinical symptoms depending on the associated cardiac disorder. Coronary artery fistulas originated from the proximal left descending artery (n=10), left main stem (n=3), circumflex artery (n=1), right coronary artery (n=1), and drained into the main pulmonary artery (n=14) and left ventricle (n=1). Nine fistulas (60%) were interrupted on the outside of the heart, and six fistulas (40%) were closed through the opened pulmonary artery. There was no surgical death and no fistula-related complication. CONCLUSIONS: Surgical closure of congenital coronary artery fistulas in adults can be performed with a very low risk, and closure is recommended to prevent complications.     

Combined Surgical Treatment of Atherosclerotic Coronary Artery Disease and Moderate Aortic Valve Stenosis in Patient with Concomitant Lipton’s R-III Type of Single Coronary Artery Anomaly

A single coronary artery is a very rare condition, commonly associated with other congenital anomalies. It could be generally considered as neither benign nor malignant form of congenital coronary artery anomalies since its pathophysiological and clinical implications grossly depend on different anatomical patterns defined by the site of origin and distribution of the branches. By presenting the patient who underwent successful coronary artery bypass grafting and aortic valve replacement surgery in a presence of isolated single coronary artery, we intend to emphasize natural and procedural risks and distinguish casual from causal in this extremely rare clinical and surgical scenario.     

Hemodynamically significant anomalies of the coronary arteries. Surgical aspects

In 78 (0.9%) of 8,283 patients without associated congenital heart disease studied by angiography, one or more major elements of the coronary arterial system originated in an ectopic manner. Symptoms attributable to the aberrant vessel more present in 20 of the 78 patients and in 15 patients these anomalies were treated surgically. The hemodynamically significant anomalies which lead to abnormalities of myocardial perfusion are of particular surgical importance. There are 4 major types: 1) aberrant origin of the left anterior descending branch from the pulmonary artery; 2) origin of the left coronary artery from the right aortic sinus; 3) origin of the left coronary artery from the pulmonary artery and 4) severe atherosclerotic occlusive disease in an aberrant vessel. The incidence, angiographic features and surgical aspects of these anomalies are discussed.     

Origin of the left coronary artery from the trunk of the pulmonary artery. Report of a case

The congenital anomalies of the coronary arteries are varied. The left trunk arising from the pulmonary artery is a rare and serious one. With coronary angiography the diagnosis is possible. The surgical technics offer an effective treatment. We report the first case with these anomalies at the Instituto Nacional de Cardiología Ignacio Chávez. It was diagnosed with coronary angiography and it was treated by suturing the left main coronary artery in its origin, and with implantation of a safenous vein graft between the aorta and the left main coronary artery. The results were satisfactory.     

Surgical management of congenital coronary arterial anomalies in adults

Congenital anomalies of the coronary arteries are an uncommon, but important, cause of pain in the chest, myocardial ischaemia and even sudden cardiac death, especially in young individuals. This paper focuses on the surgical treatment of congenital anomalies of the coronary arteries in adults; indications for surgery and the different surgical options will be reviewed.     

Coronary artery anomalies: Anomalous origin of the left coronary artery and circumflex branch in two patients

Coronary anomalies may be isolated defects or accompany congenital malformations of the heart. The determination of these anomalies is important in the treatment approach and the surgical procedure in bypass and valve surgery. The present article reports on clinical and angiographic findings in two patients with coronary artery anomalies -one patient with an anomalous origin of the left coronary artery from the right aortic sinus, and another patient with an anomalous origin of the circumflex branch of the left coronary artery from the right coronary artery.     

Anomalies of coronary arteries

Concealed undiagnosed congenital anomalies of coronary arteries (CACA) can cause sudden death of young men. Isolated CACA are detected at 0.6-1.8% of coronary angiographies. Classification of CACA (2002) includes anomalous origin of coronary artery from pulmonary artery, anomalous origin of coronary artery from the aorta, congenital atresia of the left main coronary artery, coronary arteriovenous fistula, coronary artery with myocardial bridge, coronary artery aneurism, coronary artery stenosis. In most cases coronary artery anomalies for long time remain asymptomatic. Clinical picture of anomalous origin of coronary artery from pulmonary artery is often erroneously related to cardiomyopathy or myocarditis because of signs of heart failure. Modern methods of visualization are used for diagnosis of CACA: echocardiography (transthoracic and transesophageal), computer angiotomography (electron beam tomography, multispiral computer tomography), magnetic resonance angiography, thallium stress scintigraphy, single photon positron emission tomography, dobutamine stress echocardiography, endovascular ultrasound study. Coronary angiography is the gold standard for diagnosis of congenital anomalies of coronary arteries. Drug therapy, transluminal balloon angioplasty with stenting or surgical revascularization are indicated to patients with overt clinical picture.