Shikata Fumiaki, Nagashima Mitsugi, Higaki Takashi, Kawachi Kanji
Department of Cardiovascular Surgery, Ehime University, Shitsukawa, Toon City, Ehime 791-1125, Japan.
Interact Cardiovasc Thorac Surg. 2010 Apr;10(4):639-41. doi: 10.1510/icvts.2009.226241. Epub 2010 Jan 6.
Occlusion of the right coronary artery (RCA) ostium by an aortic cusp is a rare anomaly and can be a cause of sudden death. We report the case of a child with progressive stenosis of the right coronary ostium caused by a hypoplastic right coronary cusp that adhered to the aortic wall resulting in severe myocardial ischemia. The patient underwent a Ross-Konno operation with mitral valvuloplasty for congenital aortic valvular stenosis and mitral regurgitation caused by ischemia-induced posteromedial papillary muscle dysfunction. The myocardial ischemia was relieved by resection of the deformed pouch-like cusp to disclose the RCA ostium. Postoperative myocardial scintigraphy demonstrated no myocardial ischemia and multidetector computed tomography showed no coronary ostial stenosis.
主动脉瓣叶阻塞右冠状动脉（RCA）开口是一种罕见的异常情况，可能是猝死的原因。我们报告一例儿童病例，其右冠状动脉开口因发育不良的右冠状动脉瓣叶粘连至主动脉壁导致进行性狭窄，进而引起严重心肌缺血。该患者因先天性主动脉瓣狭窄以及缺血性后内侧乳头肌功能障碍所致二尖瓣反流，接受了Ross-Konno手术及二尖瓣成形术。通过切除变形的袋状瓣叶以显露右冠状动脉开口，心肌缺血得以缓解。术后心肌闪烁显像显示无心肌缺血，多层螺旋计算机断层扫描显示无冠状动脉开口狭窄。
