左冠状动脉起源于肺动脉的外科治疗

目的　探讨左冠状动脉起源于肺动脉的术前诊断、手术治疗的术式和疗效。　方法　1991年 8月～ 1999年 3月 ,8例患者进行了手术治疗 ,其中 7例采用肺动脉内隧道成形术 ,1例采用冠状动脉旁路移植术 ,1例患者合并二尖瓣关闭不全 ,同时进行了二尖瓣成形术。术前进行了心电图、心脏超声和心导管、心脏造影等全面检查。术后随访 7例 ,随访时间平均 (4 6 8± 10 7)个月。　结果　 8例患者无住院死亡和严重并发症 ,7例随访无晚期死亡 ,1例患者因肺动脉内隧道缝线撕脱 ,导致主动脉 主肺动脉瘘 ,二次手术修补成功。随访患者NYHA心功能Ⅰ级 ,LVED平均 (4 6 4± 3 7)mm ,较术前平均 (5 4 4± 2 8)mm明显减少 (P <0 0 1) ,EF值 (6 9 4± 2 3) %较术前 (5 9 6± 2 8) %明显提高(P <0 0 5 )。　结论　左冠状动脉起源于肺动脉是一种较为罕见的先天性心脏病 ,治疗的主要原则为重建 2支冠状动脉系统并处理好合并病变。肺动脉内隧道矫治方法 ,简便易行 ,疗效满意

Surgical treatment of anomalous origin of the left coronary artery from the pulmonary artery

OBJECTIVE: To introduce the experience in surgical correction of anomalous origin of the left coronary artery from the pulmonary artery in 8 patients. METHODS: From 1991 August to 1999 March, 8 patients underwent surgery. Intrapulmonary tunnel procedure was performed in 7 patients, and coronary artery bypass grafting using the saphenous vein in 1. Mitral valve incompetence was repaired in 1 patient. ECG, echocardiographic and angiographic studies were made in all patients. 7 patients were followed up for 327 months (mean 46.8 +/- 10.7) months. RESULTS: No hospital deaths and later deaths occurred nor major complications during hospitalization. Because of suture of intrapulmonary tunnel loose, artery-pulmonary artery leakage 1 patient was reoperated on successfully. Follow-up showed cardiac function New York Heart Association function class I, mean LVMD (46.4 +/- 3.7) mm, vs mean (54.4 +/- 2.8) mm before the operation (P < 0.01), and mean EF (69.4 +/- 2.3)% vs mean 59.6% +/- 2.8% before the operation (P < 0.05). CONCLUSIONS: Ananomalous origin of the left coronary artery from the pulmonary artery is a very rare congenital malformation. To correct the anomalous origin of the left coronary artery from the pulmonary artery is to reconstruct the normal two-coronary system and to treat the other associated diseases. Intrapulmonary tunnel operation is easy to perform satisfactorily.