Kadi Hasan, Kurtoglu Nuri, Karadag Bilgehan
Department of Cardiology, Gebze State Hospital, Istanbul, Turkey.
Cardiology. 2007;108(4):314-6. doi: 10.1159/000099101. Epub 2007 Feb 9.
We describe a unique case of congenital absence of a right pulmonary artery presenting in a patient of advanced age and initially misdiagnosed as coronary artery disease. Perfusion of the affected lung was accomplished via anomalous collaterals from right and left circumflex coronary arteries which induced myocardial ischemia, as demonstrated by myocardial perfusion scan. To our knowledge there are only three reports in the international literature, describing unilateral pulmonary artery agenesis with the coronary artery supplying the abnormal lung. All these reports described that the existence of such vessels does not affect the myocardial perfusion. However, here we describe, to our knowledge, for the first time that in a patient with unilateral pulmonary artery agenesis, the existence of collaterals from the coronary arteries to the affected lung can actually have a negative effect in myocardial perfusion and can induce myocardial ischemia. In conclusion, clinicians should be aware of the possibility of undiagnosed cases of unilateral pulmonary artery agenesis presenting with chest pain in advanced age.
我们描述了一例独特的先天性右肺动脉缺如病例，该病例发生在一名老年患者身上，最初被误诊为冠状动脉疾病。通过左右冠状动脉回旋支的异常侧支实现了对患侧肺的灌注，心肌灌注扫描显示这导致了心肌缺血。据我们所知，国际文献中仅有三篇报告描述了单侧肺动脉发育不全且冠状动脉为异常肺供血的情况。所有这些报告均表明此类血管的存在不影响心肌灌注。然而，在此我们首次描述，据我们所知，在一名单侧肺动脉发育不全的患者中，冠状动脉至患侧肺的侧支血管的存在实际上可对心肌灌注产生负面影响并诱发心肌缺血。总之，临床医生应意识到老年患者出现胸痛时存在未被诊断的单侧肺动脉发育不全病例的可能性。
