Samarendra P, Kumari S, Hafeez M, Vasavada B C, Sacchi T J
Department of Medicine, Long Island College Hospital, Brooklyn, NY, USA.
Angiology. 2001 Aug;52(8):521-6. doi: 10.1177/000331970105200803.
Anomalous origin of the circumflex coronary artery from the right sinus of Valsalva is the most common coronary anomaly and is usually considered benign. Although several researchers in the past believed that aberrancy predisposes this vessel to accelerated atherosclerosis, this could not get wide acceptance owing to lack of convincing data. To examine the suggestion that atherosclerosis affects the anomalous circumflex artery more severely, the authors reviewed the clinical and angiographic features of patients with this anomaly identified from 2,684 coronary angiography procedures performed between January 1998 and March 2000 at their institution. The degree of atherosclerotic narrowing in the anomalous artery was compared with that in other coronary arteries in the same patient as well as in the nonanomalous circumflex arteries in controls. For comparison 3 control subjects were selected for each patient with anomalous circumflex artery, matched by age, sex, and clinical presentations. The results showed earlier and greater degree of atherosclerotic narrowing of the anomalous artery as compared to the other coronary arteries in the same patients as well as to nonanomalous circumflex arteries of age- and gender-matched control subjects with similar clinical characteristics. However, this predilection for atherosclerosis was evident only in anomalous vessels arising from the right side and pursuing a retroaortic course. The anomalous artery was responsible for myocardial infarction in 3 patients, all of whom were 60 years or older. Two of the patients with this anomaly and myocardial infarction underwent successful angioplasty with stent placement for symptomatic relief.
回旋支冠状动脉起源于右冠窦是最常见的冠状动脉异常，通常被认为是良性的。尽管过去有几位研究者认为这种异常会使该血管更容易发生动脉粥样硬化加速，但由于缺乏令人信服的数据，这一观点并未得到广泛认可。为了检验动脉粥样硬化对异常回旋支动脉影响更严重这一观点，作者回顾了1998年1月至2000年3月在其机构进行的2684例冠状动脉造影检查中发现的患有这种异常的患者的临床和血管造影特征。将异常动脉的动脉粥样硬化狭窄程度与同一患者的其他冠状动脉以及对照组的正常回旋支动脉进行比较。为了进行比较，为每例异常回旋支动脉患者选择3名对照者，根据年龄、性别和临床表现进行匹配。结果显示，与同一患者的其他冠状动脉以及具有相似临床特征的年龄和性别匹配的对照者的正常回旋支动脉相比，异常动脉的动脉粥样硬化狭窄出现得更早且程度更严重。然而，这种对动脉粥样硬化的易感性仅在起源于右侧并走行于主动脉后方的异常血管中明显。异常动脉导致3例患者发生心肌梗死，所有患者均为60岁或以上。其中2例患有这种异常并发生心肌梗死的患者接受了成功的血管成形术并置入支架以缓解症状。
