Resley Justin, Burke Ryan, Isbell David, Tribble Reid, Martin Jeffery, Petit Scott
Palmetto Health Heart Hospital, Columbia, SC, USA.
Perfusion. 2010 Jul;25(4):245-7. doi: 10.1177/0267659110373841. Epub 2010 Jun 1.
Coronary arteries originating from the opposite coronary cusp and crossing the path between the aorta and the pulmonary artery are associated with ischemia and sudden cardiac death. An increased prevalence of these cases may be attributed to diagnostic advances in computed tomographic angiography (CTA). We report a retrospective review of ten patients referred for surgical intervention from March 2008 to present. Nine patients were diagnosed with right coronary arteries arising from the left coronary cusp and one patient with a left coronary artery arising from the right coronary cusp. Seven patients were male and the median age was 40 years (range, 21 to 51). Symptoms included atypical chest pain, tachy-arrythmias, diaphoresis, and dyspnea on exertion. CTA demonstrated anomalous coronary arteries arising from the opposite coronary cusp and traveling between the aorta and the pulmonary artery. Surgical intervention was performed on all ten patients with no mortality and only one re-operation requiring bypass grafting. The sixth patient in the series had concomitant atherosclerotic disease, requiring left internal mammary artery grafting to the left anterior descending coronary artery. Cardiopulmonary bypass (CPB) was utilized with moderate hypothermia in all ten patients, with retrograde and/or coronary ostial cardioplegia administration. At routine surgical follow-up, all patients were without original presenting symptoms. Patients with anomalous coronary arteries arising from the opposite coronary cusp are at risk of acute myocardial infarction and sudden cardiac death. Surgical unroofing is a viable option for this patient population and avoids coronary artery bypass grafting. Since March 2008, we have operated on ten patients presenting with this anomaly and have had excellent short-term results. Further long-term follow-up is necessary.
起源于对侧冠状动脉瓣叶并跨越主动脉与肺动脉之间路径的冠状动脉与缺血及心源性猝死相关。这些病例患病率的增加可能归因于计算机断层血管造影（CTA）诊断技术的进步。我们报告了对2008年3月至今转诊接受手术干预的10例患者的回顾性研究。9例患者诊断为右冠状动脉起源于左冠状动脉瓣叶，1例患者为左冠状动脉起源于右冠状动脉瓣叶。7例为男性，中位年龄40岁（范围21至51岁）。症状包括非典型胸痛、快速性心律失常、出汗及劳力性呼吸困难。CTA显示冠状动脉异常起源于对侧冠状动脉瓣叶并走行于主动脉与肺动脉之间。所有10例患者均接受了手术干预，无死亡病例，仅1例因需要冠状动脉搭桥术而再次手术。该系列中的第6例患者合并有动脉粥样硬化疾病，需要行左乳内动脉至左前降支冠状动脉搭桥术。所有10例患者均在中度低温下使用体外循环（CPB），并给予逆行和/或冠状动脉开口处心脏停搏液。在常规手术随访中，所有患者均无最初的症状表现。冠状动脉异常起源于对侧冠状动脉瓣叶的患者有急性心肌梗死和心源性猝死的风险。手术开窗术是这类患者的可行选择，可避免冠状动脉搭桥术。自2008年3月以来，我们已对10例有此异常表现的患者进行了手术，短期效果良好。有必要进行进一步的长期随访。
