起源于右冠状动脉后外侧分支的窦房结动脉：通过连续1500例冠状动脉造影筛查的定义

Sinoatrial node artery arising from posterolateral branch of right coronary artery: definition by screening consecutive 1500 coronary angiographies.

作者信息

Okmen Arda Sanli, Okmen Ertan

机构信息

Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey.

出版信息

Anadolu Kardiyol Derg. 2009 Dec;9(6):481-5.

PMID:19965320

Abstract

OBJECTIVE

Sinoatrial node (SAN) artery originates from proximal segment of right coronary artery (RCA) or from left circumflex artery. Sinoatrial node artery artery originating from posterolateral (PL) branch of RCA is very rare. Only several cases have been reported. The study was performed to seek the frequency of this variation, evaluate clinical relevance, and describe electrocardiographic, angiographic characteristics of patients.

METHODS

Consecutive 1500 coronary angiography were screened to detect specifically SAN artery originating from PL branch of RCA. Patients with this variation were followed-up for one year regarding the arrhythmic events.

RESULTS

The origin of SAN artery was proximal RCA in 1280 (85%), circumflex artery in 208 (14%), and PL branch of RCA in 12 (0.8%) patients (8 male, 4 female, mean age 64+/- 9 years). There was no history of arrhythmia in all patients. One patient presented with atrioventricular block. Indications of angiography were stable angina in 5, unstable angina in 5, and acute myocardial infarction in 2 patients. The patient with inferior myocardial infarction due to RCA total occlusion did not develop bradycardia or conduction defect. In four patients (33%) there was another artery originating from proximal RCA, ending at same territory with the variant artery suggesting dual blood supply. During one-year follow-up none of the patients experienced arrhythmic event.

CONCLUSIONS

Sinoatrial node artery originating from distal RCA is very rare. This variation, even in patients with severe RCA disease is not associated with severe arrhythmia. Dual blood supply may be a protective factor in this subgroup of patients from arrhythmic events. To be aware of the origin and course of variant SAN artery may provide safe approach to interventional cardiologist and cardiac surgeon during percutaneous and surgical coronary and atrial interventions.

摘要

目的

窦房结（SAN）动脉起源于右冠状动脉（RCA）近端或左旋支动脉。起源于RCA后外侧（PL）分支的窦房结动脉非常罕见。仅报道过几例。本研究旨在探寻这种变异的发生率，评估其临床相关性，并描述患者的心电图及血管造影特征。

方法

对连续1500例冠状动脉造影进行筛查，以专门检测起源于RCA的PL分支的窦房结动脉。对有这种变异的患者进行为期一年的心律失常事件随访。

结果

1280例（85%）患者的窦房结动脉起源于RCA近端，208例（14%）起源于左旋支动脉，12例（0.8%）起源于RCA的PL分支（8例男性，4例女性，平均年龄64±9岁）。所有患者均无心律失常病史。1例患者出现房室传导阻滞。血管造影的指征为5例稳定型心绞痛、5例不稳定型心绞痛和2例急性心肌梗死。因RCA完全闭塞导致下壁心肌梗死的患者未出现心动过缓或传导缺陷。4例患者（33%）有另一支动脉起源于RCA近端，与变异动脉终止于同一区域，提示双重血液供应。在一年的随访中，所有患者均未发生心律失常事件。