Kang Woong Chol, Chung Wook-Jin, Choi Chang Hyu, Park Kook Yang, Jeong Mi Jin, Ahn Tae Hoon, Shin Eak Kyun
Int J Cardiol. 2007 Feb 7;115(2):e63-7. doi: 10.1016/j.ijcard.2006.07.194. Epub 2006 Nov 13.
A 41-year-old woman with no modifiable coronary risk factors presented with a progressive exertional dyspnea. Chest radiography showed an enlarged cardiac silhouette with reinforced pulmonary vasculature in bilateral lower lung fields and both pleural effusion. Echocardiography revealed a dilated, globally hypokinetic left ventricle with an ejection fraction of 40%. Multislice cardiac computed tomography revealed abnormal origin of LCA from the main pulmonary artery receiving collaterals from a normally originating dilated tortuous right coronary artery. Coronary angiography revealed a single, large, and tortuous RCA arising from the right sinus of Valsalva and giving off extensive collateral vessels coursing over the right ventricular wall, the interventricular septum, and the apex to the left coronary artery that was drained into the proximal main pulmonary. The diagnosis of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) was confirmed. The patient underwent successful reimplantation of LCA to aorta after closure of the ostium (in the main pulmonary artery) of the anomalously originating LCA. After surgical and medical treatment, the patient's symptoms were relieved and both pleural effusions were improved on chest radiography. After then, the patient was discharged on medication.
一名41岁无可控性冠状动脉危险因素的女性，出现进行性劳力性呼吸困难。胸部X线检查显示心脏轮廓增大，双侧下肺野肺血管纹理增强，双侧胸腔积液。超声心动图显示左心室扩张，整体运动减弱，射血分数为40%。多层螺旋心脏计算机断层扫描显示左冠状动脉起源异常，起自主肺动脉，接受一条正常起源的扩张迂曲右冠状动脉发出的侧支供血。冠状动脉造影显示一条粗大迂曲的右冠状动脉发自主动脉窦，发出广泛的侧支血管跨越右心室壁、室间隔和心尖至左冠状动脉，左冠状动脉汇入近端主肺动脉。左冠状动脉起源于肺动脉（ALCAPA）的诊断得以证实。该患者在异常起源的左冠状动脉（在主肺动脉内）开口闭合后，成功将左冠状动脉重新植入主动脉。经过手术和药物治疗，患者症状缓解，胸部X线检查显示双侧胸腔积液改善。此后，患者出院并继续服药。
