Seo T, Ikeda Y, Fujita H, Hayashi T, Kawaguchi K, Kotake C, Toda T, Kobayashi K, Tsujino H, Takeuchi Y
Department of Internal Medicine, Osaka Saiseikai Nakatsu Hospital.
Kokyu To Junkan. 1991 Oct;39(10):1043-7.
A 56-year-old man visited our hospital for further examination of resting electrocardiographic abnormality. Positive exercise stress resulted in mild chest discomfort and 1.5 mm ST depression in II.III.aVF leads. Myocardial imaging perfusion with thallium-201 was normal and an anomalous origin of the left circumflex coronary artery from the right aortic sinus was observed by coronary angiography. MRI showed that the vessel running behind the aorta was connected to the right Valsalva's sinus. Furthermore, transesophageal echocardiography revealed that the vessel connected to the lateral wall of the left ventricle was running from the right Valsalva's sinus between the aorta and left atrium. The above results indicated that this vessel was the left circumflex artery. Although myocardial infarction or sudden death in patients with coronary anomaly has been discussed, the mechanism is still unknown. The present case is a rare one in which the anatomical relation between the anomalous coronary and the great vessels was directly detectable by transesophageal echocardiography. Transesophageal echocardiography is useful for the assessment of this type of coronary anomaly.
一名56岁男性因静息心电图异常前来我院进一步检查。运动负荷试验阳性，导致轻度胸部不适，II、III、aVF导联ST段压低1.5毫米。铊-201心肌灌注显像正常，冠状动脉造影显示左旋支冠状动脉起源于右主动脉窦。磁共振成像显示，走行于主动脉后方的血管与右瓦尔萨尔瓦窦相连。此外，经食管超声心动图显示，连接至左心室侧壁的血管发自右瓦尔萨尔瓦窦，走行于主动脉与左心房之间。上述结果表明，该血管为左旋支动脉。尽管已对冠状动脉异常患者发生心肌梗死或猝死的情况进行了讨论，但其机制仍不清楚。本病例较为罕见，经食管超声心动图可直接检测到异常冠状动脉与大血管之间的解剖关系。经食管超声心动图对评估此类冠状动脉异常很有用。
