右冠状动脉起源于左主干5例临床分析

目的：分析右冠状动脉起源于左主干的临床特征，探讨其与心肌缺血的关系。方法：回顾分析5例右冠状动脉起源于左主干的临床资料及相关文献。结果：（1）本组5例患者中，女性1例，男性4例，年龄27～70岁。（2）临床表现主要为胸痛、胸闷等心绞痛症状，除1例老年患者外，其余4例病人都有典型的心绞痛症状和缺血心电图变化。（3）冠状动脉造影示3例合并严重冠状动脉粥样硬化，给予冠状动脉搭桥术，术后随访2月～6年无明显不适；另2例冠状动脉无明显病变，药物治疗后仍有劳累性心绞痛发作，其中1例半年后猝死。结论：右冠状动脉起源于左主干是一种罕见的冠脉畸形，对存在严重心肌缺血的患者应进行预防性冠状动脉搭桥术或介入治疗，预防不良事件的发生。

Right coronary artery originate from 1eft main coronary artery: clinical analysis of 5 cases

Objective: To study the clinical characteristics of right coronary artery(RCA)originating from the left main coronary artery(LMCA),and to evaluate the correlation between the anomalous RCA and myocardial ischemia. Methods: Five cases of RCA originating from the LMCA and the related literatures were reviewed. Results: 1) Four male and one female were included in the group with age ranging from 27 to 70 years old. 2) The clinical manifestations included chest pain or distress, breathlessness and other symptoms of the angina pectoris. 4 patients showed typical angina pectoris and typical ischemia electrocardiogram changes except for one old patient. 3) Diagnosis of RCA originating from the LMCA could be depended on coronary arteriography. Three of the five cases with serious coronary artery stenosis accepted coronary artery bypass grafting and their courses had been uneventful during 2 month-6 years' follow-up. The other two cases whose coronary angiography showed no serious coronary artery stenosis preferred long-term medical therapy and they still suffered angina during medical therapy and one had suffered from sudden death after 6 months. Conclusions: RCA originating from the LMCA is a rare and serious coronary artery abnormity, and it should be warranted prophylactic coronary artery bypass surgery in patients with high risk of sudden death or severe myocardial ischemia.