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。     

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.     

The prevalence of coronary artery anomalies in Qassim Province detected by cardiac computed tomography angiography

Background

Coronary artery anomalies (CAAs) affect about 1% of the general population based on invasive coronary angiography (ICA) data, computed tomography angiography (CTA) enables better visualization of the origin, course, relation to the adjacent structures, and termination of CAAs compared to ICA.

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。     

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.     

少见冠状动脉畸形18例

目的 :探讨 18例少见冠状动脉 (冠脉 )畸形特征及评价选择性冠脉造影在其诊断中的作用。方法 :对17例患者进行冠脉造影 ,13例患者进行手术纠正治疗。另 1例二维超声心动图误诊为动脉导管未闭 ,术中证实为右冠脉 -右室瘘。结果 :18例患者中共发现有 9种冠脉畸形 ,包括冠脉起源异常 2例 ;左冠脉回旋支缺如 1例 ;左、右冠脉 -肺动脉瘘 3例 ;左冠脉 -肺动脉瘘 3例 ;右冠脉 -右心房瘘 3例 ;右冠脉 -右室瘘 2例 ;右冠脉 -静脉瘘 1例 ;左冠脉 -右室瘘 1例 ;左冠脉 -左心室瘘 2例。其中 13例患者经手术治疗得到再证实。结论 :冠脉畸形是少见的先天性血管畸形 ,选择性冠脉造影是确诊的重要手段 ,需与先天性心脏病和冠心病心绞痛鉴别 ,术后效果良好。     

Double right coronary artery detected on coronary computed tomography angiography: A case report

Double right coronary artery is a relatively rare coronary anomaly. In this case report we aim to increase awareness of the importance of recognizing such anomaly and a brief literature review of similar cases and possible high risk features. Computed Tomography is well recognized modality to detect coronary anomaly and in our case we demonstrated this as well.     

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。     

Triple origin of left coronary arteries from right coronary artery: Unusual case of single coronary artery

A rare case of coronary anomaly is presented: all of the coronary arteries originated from a single ostium located in the right coronary cusp. No clinical evidence of coronary pathology was recognized until the age of 57 years when the patient was found to have coronary obstructive disease. The single coronary artery had a main branch corresponding to the usual dominant right coronary artery. Three other branches separated from this and vascularized the areas normally receiving the circumflex and ramus medianus, the left anterior descending, and a large septal branch.     

Overview of coronary artery variants,aberrations and anomalies

Coronary artery anomalies and variants are relatively uncommon congenital disorders of the coronary artery anatomy and constitute the second most common cause of sudden cardiac death in young competitive athletes. The rapid advancement of imaging techniques, including computed tomography, magnetic resonance imaging, intravascular ultrasound and optical coherence tomography, have provided us with a wealth of new information on the subject. Anomalous origin of a coronary artery from the contralateral sinus is the anomaly most frequently associated with sudden cardiac death, in particular if the anomalous coronary artery has a course between the aorta and the pulmonary artery. However, other coronary anomalies, like anomalous origin of the left coronary artery from the pulmonary artery, atresia of the left main stem and coronary fistulae, have also been implicated in cases of sudden cardiac death. Patients are usually asymptomatic, and in most of the cases, coronary anomalies are discovered incidentally during coronary angiography or on autopsy following sudden cardiac death. However, in some cases, symptoms like angina, syncope, heart failure and myocardial infarction may occur. The aims of this article are to present a brief overview of the diverse coronary variants and anomalies, focusing especially on anatomical features, clinical manifestations, risk of sudden cardiac death and pathophysiologic mechanism of symptoms, as well as to provide valuable information regarding diagnostic workup, follow-up, therapeutic choices and timing of surgical treatment.     

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。     

Coronary artery disease in congenital single coronary artery in adults:A Dutch case series

AIM:To assess the current diagnostic and therapeutic management and the clinical implications of congenital single coronary artery(SCA) in adults.METHODS:We identified 15 patients with a SCA detected from four Dutch angiography centers in the period between 2010 and 2013.Symptomatic patients who underwent routine diagnostic coronary angiography(CAG) for suspected coronary artery disease and who incidentally were found to have isolated SCA were analyzed.RESULTS:Fifteen(7 females) with a mean age of 58.5 ± 13.78 years(range 43-86) had a SCA.ConventionalCAG demonstrated congenital isolated SCA originating as a single ostium from the right sinus of Valsalva in 6 patients and originating from the left in 9 patients.Minimal to moderate coronary atherosclerotic changes were found in 4,and severe stenotic lesions in another 4 patients.Seven patients were free of coronary atherosclerosis.Runs of non-sustained ventricular tachycardia were documented in 2 patients,one of whom demonstrated transmural ischemic changes on presentation.Myocardial perfusion scintigraphic evidence of transmural myocardial ischemia was found in 1 patient due to kinking and squeezing of the SCA with an interarterial course between the aorta and pulmonary artery.Multi-slice computed tomography(MSCT) was helpful to delineate the course of the anomalous artery relative to the aorta and pulmonary artery.Percutaneous coronary intervention was successfully performed in 3 patients.Eight patients were managed medically.Arterial bypass graft was performed in 4 patients with the squeezed SCA.CONCLUSION:SCA may be associated with transient transmural myocardial ischemia and aborted sudden death in the absence of coronary atherosclerosis.The availability and sophistication of MSCT facilitates the delineation of the course of a SCA.We present a Dutch case series and review of the literature.     

95例拟诊冠心病心绞痛患者冠状动脉造影分析

目的:总结95例临床拟诊冠心病心绞痛患者的冠状动脉造影结果,分析其临床症状及其心电图ST-T改变与冠状动脉造影确诊冠心病的相关性。方法:从发作性胸痛、胸闷为主诉或伴心电图ST-T改变的患者中,筛选出符合或疑似心绞痛,并经心脏超声、胸片检查排除了其他心脏病患者95例,其中典型心绞痛36例;疑似心绞痛的非典型胸痛59例;伴有ST-T改变者87例(缺血型改变25例、非特异性改变62例)。分别接受选择性冠状动脉造影。血管内径狭窄≥50%为造影阳性,诊断冠心病的依据。结果:95例患者造影阳性的45例,其中36例典型心绞痛造影者阳性34例(伴ST-T典型缺血型改变23例、非特异性改变者10例、无改者1例),阳性率94.44%;59例非典型胸痛造影阳性11例(伴非特异性ST-T改变),阳性率18.64%。两组阳性率有显著差异(P<0.01)。结论:典型心绞痛患者冠脉造影诊断冠心病相关性高,非典型胸痛或心电图非特异性ST-T改变患者冠脉造影诊断冠心病阳性率低。     

Coronary artery anomalies: A diagnostic challenge

Coronary artery anomalies (CAAs) are found in approximately 1% of all patients undergoing coronary angiography and in 0.3% of patients undergoing autopsy (Roberts, 1986). CAAs may be classified into those of origin and course, intrinsic coronary arterial anatomy, and coronary termination (Angelini et al. 2002). The most common malformation is abnormal origin and course, origin of a coronary artery from a wrong aortic sinus of Valsalva; either the right from the left coronary sinus or the left from the right coronary sinus; these anomalies must be excluded in young adults with typically ischemic- sounding chest pain or syncope. Anomalies coronary artery termination typically presented as coronary artery fistula, commonly the right coronary artery is affected, although, left sided coronary artery fistulae are well documented (Gandy et al. 2004). The anomalies of intrinsic coronary arterial anatomy, such as ostial stenosis, Artesia, and single, absent, or hypoplastic coronary arteries are rare but may have clinical importance.     

Malnutrition in patients with coronary artery disease: Prevalence and mortality in a 46,485 Chinese cohort study

Background and aimsMalnutrition is associated with poor prognosis in a wide range of illnesses. However, its long-term prognostic impact in general coronary artery disease (CAD) patients is not well known. We aim to report the prevalence and long-term mortality of malnutrition in the whole general population.Methods and resultsIn this retrospective cohort study, the controlling nutritional status (CONUT) score was applied to 46,485 consecutive patients undergoing coronary angiography (CAG) and diagnosed with CAD from January 2007 to July 2018. Patients were stratified as having no malnutrition (n = 19,780), mild (n = 21,092), moderate (n = 5286) and severe malnutrition (n = 327), based on CONUT score. Overall, mean age was 63.1 ± 10.7 years, and 75.8% of patients (n = 35,250) were male. 45.4% of patients were mildly malnourished and 12.1% were moderately or severely malnourished. During a median follow-up of 5.1 years (interquartile range: 3.0–7.7 years), 6093 (17.3%) patients died. After adjusting for confounders, malnutrition risk was associated with significantly increased risk for all-cause death (mild vs. normal, HR = 1.19,95% confidence interval [CI]: 1.12 to 1.28; moderate vs. normal, HR = 1.42,95% CI: 1.30 to 1.55; severe vs. Normal, HR = 1.95, 95% CI: 1.57 to 2.41) (p for trend<0.001). The similar result on all-cause mortality was also found in different subgroups stratified by gender, chronic kidney disease, anemia, percutaneous coronary intervention.ConclusionsMalnutrition is a common complication among patients with CAD, and is strongly associated with increased mortality. Further studies need to explore the efficacy of nutritional interventions on long-term prognosis among CAD patients.This study was registered at Clinicaltrials.gov as NCT04407936.     

糖尿病合并冠心病患者的冠脉造影分析

目的 旨在观察２型糖尿病合并冠心病患者的冠脉病变情况。方法 应用ＪＵＤＫＩＮＳ方法对６６例２型糖尿病合并冠心病患者进行冠脉造影检查,并与６６例年龄,性别配对的非糖尿病冠心病患者比较。结果 ２型糖尿病患者的冠脉病变多数是三支血管病变,其病变弥漫,且数目多;并且糖尿病的病程越长,越易发生多支血管病变,造成治疗上的困难。结论２型糖尿病的及早预防,合理有效的治疗对冠心病的防治甚为重要。     

Left-circumflex coronary artery to right atrium fistula with saccular aneurysm and its endovascular treatment

The combination of coronary artery aneurysm and coronary artery fistula is infrequent. A saccular aneurysm of a branch of the left-circumflex coronary artery associated with multiple fistulae to the right atrium was observed on a coronary angiogram performed in a 47-year-old female. Multidetector computed tomography coronary angiography detailed the anatomy of the abnormal coronary artery. An embolization with a microcoil was performed and the aneurysm sac was excluded.     

微量尿蛋白与冠状动脉病变相关性研究

目的：分析微量尿蛋白与冠状动脉病变程度和范围的相关性。方法：入选连续179例冠状动脉造影患者,根据尿白蛋白肌酐比值(UACR)分为微量尿蛋白组(30～300μg/mg,n=43)和对照组(UACR＜30μg/mg,n=136)。比较两组冠状动脉造影结果差异,同时分析微量尿蛋白与冠状动脉病变之间的相关性。结果：与对照组相比,微量蛋白尿组高血压、糖尿病患者多见,且其造影阳性率(46．51%比30．15%,P＜0．05)、多支冠状动脉病变发病率(30．23%比8．82%,P<0．01)显著增高。结论：微量蛋白尿患者更易发生严重的冠状动脉病变。     

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。     

冠心病合并肾动脉狭窄危险因素及临床意义

目的　探讨冠心病合并肾动脉狭窄发病率及危险因素 ,以及冠状动脉造影同时行肾动脉造影的必要性。方法　对 114例接受冠状动脉造影患者同时行肾动脉造影。结果　 114例患者中 ,肾动脉狭窄发病率 18 4% ,经冠状动脉造影证实的 77例冠心病中肾动脉狭窄发病率 2 6 % ,冠状动脉造影正常的 37例中肾动脉狭窄发病率 2 7% ,冠心病患者中肾动脉狭窄发病率明显高于非冠心病组(P <0 0 1)。结论　冠心病患者有较高的肾动脉狭窄的发生率 ,应该在冠状动脉造影明确冠状动脉病变后 ,常规行肾动脉造影。