儿童冠状动脉起源异常的临床分析（附7例报告）

目的 总结冠状动脉起源异常(coronary artery origin anomalies,CAOA)的临床及检查特点，为及时诊断及治疗提供一定的依据。方法 对我院2000-2008年经心脏彩超及选择性冠状动脉造影确诊的冠状动脉起源异常7例患者的临床症状，体征，辅助检查，诊断及治疗方法进行回顾性分析。结果 左旋支起源于肺动脉1例，左前降支开口于右冠状动脉窦1例，左前降支异常起源于肺动脉1例，左冠状动脉异常起源于肺动脉前窦1例，左冠状动脉异常起源于肺动脉2例，右冠状动脉起源于肺动脉1例。误诊为扩张型心肌病3例，误诊为心内膜弹力纤维增生症2例，误诊为心肌致密化不全1例，误诊为冠状动脉-肺动脉漏1例。结论 儿童冠状动脉起源异常极易误诊为心内膜弹力纤维增生症及心肌病，提高临床及超声心动图医师对该病的认识，及时诊断及治疗对于提高患儿生存率有重要意义

Clinic analyses of coronary artery origin anomalies of child

Objective To summarize the clinic and auxiliary examination characteristics of children with coronary artery origin anomalies，and offer the basis of clinic for diagnosis and treatment in time. Methods Retrospective analyses of clinical symptom, physical sign, auxiliary examination, diagnosis and treatment of 7 patients with coronary artery origin anomalies that had definited by echocardiogram and cardiac catheter in my hospital in 2000-2008. Result Left circumflex origin from pulmonary artery in 1 case. Anterior discending branch open to right coronary artery sinus in 1 case. Anomalous origin of Left anterior descending branch from pulmonary artery in 1 case. Anomalous origin of coronary artery from pulmonary anterior sinus in 1case. Anomalous origin of left coronary artery from pulmonary artery in 2 cases. Anomalous origin of right coronary artery from pulmonary artery in 1 case. Misdiagnosis to dilated cardiomyopathy in 3 cases. Misdiagnosis to endocardial fibroelastosis in 1 case. Misdiagnosis to monocompaction of the ventricular myocardium in 1 case. Misdiagnosis to coronary artery-pulmonary artery leakage in 1 case. Conclusion Anomalous origin of coronary artery in children are easy to misdiagnosis to endocardial fibroelastosis and cardiomyopathy. Improving the recognition, diagnosis and treatment in time of the diseases for clinician and echocardiographic physician is extremely important to elevate the suvival rate for these children.