Emery Michael, Ghumman Waqas, Teague Shawn, Mahenthiran Jo
Krannert Institute of Cardiology, Indiana University School of Medicine Indianapolis, Indiana, USA.
Vasc Health Risk Manag. 2008;4(1):259-62. doi: 10.2147/vhrm.2008.04.01.259.
A 23-year-old male referred for evaluation of a "choking" sensation with exertion and a murmur. A transthoracic echocardiogram demonstrated right atrial and ventricular dilatation, right ventricular volume overload, and a large secundum atrial septal defect (ASD) with left to right shunt and a calculated pulmonary-to-systemic blood flow ratio (Qp/Qs) estimated at 2.3 to 1. Cardiac catheterization also demonstrated evidence of the ASD with Qp/Qs of 4.6 to 1 with a significant step-up in oxygen saturation at the right atrial level. Additionally, an anomalous left main coronary artery (ALMCA) origin from the anterior right coronary cusp was suspected. Using 64-slice multidetector computed tomography coronary angiography (CCTA) the left main coronary artery was seen to arise from the right coronary cusp then traverse between the pulmonary trunk and the proximal ascending aorta before bifurcating into the left anterior descending and circumflex arteries that followed their normal courses distally. Based on the high risk nature of associated sudden death from an anomalous left main coronary artery (ALMCA) coursing between the aorta and the pulmonary trunk, the patient underwent surgical re-implantation of the ALMCA to the left coronary cusp and repair of the ASD. This case highlights a rare finding of a hazardous ALMCA in a patient with a secundum ASD and the utility of CCTA in evaluating the course of coronary anomalies along with other cardiac pathology.
一名23岁男性因运动时出现“哽噎”感及杂音前来评估。经胸超声心动图显示右心房和心室扩大、右心室容量超负荷，以及一个大型继发孔房间隔缺损（ASD），存在左向右分流，计算得出的肺循环与体循环血流量比值（Qp/Qs）估计为2.3比1。心导管检查也证实了ASD的存在，Qp/Qs为4.6比1，右心房水平氧饱和度有显著升高。此外，怀疑左冠状动脉主干（ALMCA）起源于右冠状动脉前叶瓣。使用64层多层螺旋计算机断层扫描冠状动脉造影（CCTA），可见左冠状动脉主干起源于右冠状动脉瓣，然后在肺动脉干和升主动脉近端之间穿行，之后分为左前降支和回旋支动脉，它们在远端走行正常。鉴于主动脉和肺动脉干之间走行的异常左冠状动脉主干（ALMCA）存在相关猝死的高风险特性，该患者接受了ALMCA至左冠状动脉瓣的手术再植入及ASD修复。本病例突出了继发孔ASD患者中罕见的危险ALMCA的发现，以及CCTA在评估冠状动脉异常走行及其他心脏病理情况方面的作用。
