Topaz O, DeMarchena E J, Perin E, Sommer L S, Mallon S M, Chahine R A
Cardiac Catheterization Laboratories, Division of Cardiology, University of Miami School of Medicine, Florida.
Int J Cardiol. 1992 Feb;34(2):129-38. doi: 10.1016/0167-5273(92)90148-v.
Among 13010 adults who underwent coronary arteriography, 80 (0.61%) patients had a total of 83 anomalous coronary arteries. Thirty-three (41%) of the patients were of Hispanic origin, while out of the entire population studied 30% were Hispanic. The right coronary artery was the most common anomalous vessel. It was identified in 50 (62%) patients, arising in 35 from the left aortic sinus, in 14 from the posterior sinus, and in 1 from the left coronary artery. An anomalous circumflex artery was recognized in 22 (27%) patients. Nine (11%) patients presented an anomalous left anterior descending artery, 1 patient an anomalous left main coronary artery, and another an anomalous septal perforator artery. Twenty-three (29%) patients had concomitant congenital heart abnormalities, most commonly. bicuspid aortic valve and mitral valve prolapse. In each of 5 patients with complex congenital heart disease the course of the anomalous vessel could have interfered with a surgical procedure. In 4 cases anomalous coronary arteries were associated with either anomalous systemic venous circulation or anomalous cardiac veins. In 5 (6%) patients only, the anomalous coronary artery was solely responsible for a clinical event. Coronary atherosclerosis of the anomalous arteries was found in 28% of the patients, while the overall incidence of the disease in this series was 65%. Thus, anomalous coronary arteries are associated with a high incidence of congenital heart diseases, but do not appear to be associated with an increased risk for development of coronary atherosclerosis. The angiographic recognition of these vessels is important in patients who undergo coronary angioplasty or cardiac surgery. Variations in the frequency of congenital coronary anomalies as reported herein may be attributed to a genetic background.
在13010名接受冠状动脉造影的成年人中，80名（0.61%）患者共有83条冠状动脉异常。其中33名（41%）患者为西班牙裔，而在整个研究人群中，西班牙裔占30%。右冠状动脉是最常见的异常血管。在50名（6患者（62%）患者中发现了右冠状动脉异常，其中35条起源于左主动脉窦，14条起源于后窦，1条起源于左冠状动脉。22名（27%）患者发现有异常的回旋支动脉。9名（11%）患者出现异常的左前降支动脉，1名患者出现异常的左主干冠状动脉，另1名患者出现异常的间隔穿支动脉。23名（29%）患者伴有先天性心脏异常，最常见的是二叶式主动脉瓣和二尖瓣脱垂。在5名患有复杂先天性心脏病的患者中，异常血管的走行可能会干扰手术操作。在4例中，异常冠状动脉与异常的体静脉循环或异常的心脏静脉有关。仅在5名（6%）患者中，异常冠状动脉是临床事件的唯一原因。28%的患者异常动脉存在冠状动脉粥样硬化，而本系列中该疾病的总体发病率为65%。因此，异常冠状动脉与先天性心脏病的高发病率相关，但似乎与冠状动脉粥样硬化发生风险的增加无关。在接受冠状动脉成形术或心脏手术的患者中，血管造影识别这些血管很重要。本文报道的先天性冠状动脉异常频率的差异可能归因于遗传背景。
