CTA诊断冠状动脉异常起源肺动脉

目的 探讨冠状动脉（简称冠脉）异常起源肺动脉（ACAPA）的CTA图像特征。方法 回顾性分析本院收治的24例ACAPA的患者资料，分析其CTA表现，并与手术结果对照。结果 24例患者中，发生于左冠脉20例（20/24，83.33%）、右冠脉1例（1/24，4.17%）、前降支1例（1/24，4.17%）、回旋支2例（2/24，8.33%）。冠脉异常起源部位：起源于肺动脉窦或肺动脉主干后壁11例（11/24，45.83%）、左壁7例（7/24，29.17%）、右壁4例（7/24，16.67%），起源于左肺动脉2例（2/24，8.33%）。侧支循环：婴儿型5例，冠脉间未见侧支血管；成人型19例，其中左/右冠脉异常起源16例，前降支异常起源1例，回旋支异常起源2例。合并双前降支和冠脉在升主动脉壁内走行各1例。外科手术19例。术后CTA复查5例，1例人工管道与回旋支吻合口局限性狭窄，1例右心室流出道再狭窄，1例冠脉假性动脉瘤。结论 CTA可清晰显示冠脉异常起源部位、与升主动脉的距离、侧支血管、合并其他冠脉畸形，有助于术前制定手术方式及术后随访。

CTA in diagnosis of anomalous origin of coronary artery from pulmonary artery

Objective To evaluate CTA characteristics of anomalous origin of coronary artery from the pulmonary artery (ACAPA). Methods The clinical data of 24 patients with ACAPA were retrospectively analyzed, and the results of CTA were compared with operation. Results In 24 ACAPA cases, 20 cases (20/24, 83.33%) occurred in the left coronary artery (LCA), 1 case (1/24, 4.17%) was in the right coronary artery (RCA), 1 case (1/24, 4.17%) was in the anterior descending artery (LAD) and 2 cases (2/24, 8.33%) were in the circumflex artery (LCX). The origins of coronary anomalies originated from the posterior wall of the pulmonary sinus or pulmonary trunk in 11 cases (11/24, 45.83%), left wall in 7 cases (7/24, 29.17%), right wall in 4 cases (4/24, 16.67%), originated in the left pulmonary artery in 2 cases (2/24, 8.33%). Collateral circulation: Infant type was in 5 cases, no collateral vessels between the coronary artery was observed; adult type was in 19 cases, of which 16 cases were of abnormal origin of the LCA and RCA, 1 case was of LAD, 2 cases were of LCX. The double LAD and coronary arteries with an intramural segment were found in 1 case respectively. Surgery were performed in 19 cases. Five cases were reviewed by CTA, 1 case with anastomotic stenosis of LCX, 1 case with restenosis of right ventricular outflow tract and 1 case with coronary pseudoaneurysm. Conclusion CTA can clearly show the origin of abnormal coronary artery, the distance from the ascending aorta, collateral vessels, combined with other coronary artery malformations, which can help surgical preparation of preoperative surgical approach, and postoperative follow-up.