Eng J, Beton D C, Lawson R A, Moussalli H, Nair U R, Rahman A N
Department of Cardiothoracic Surgery, Killingbeck Hospital, Leeds, U.K.
Int J Cardiol. 1991 Mar;30(3):285-8. doi: 10.1016/0167-5273(91)90004-9.
To investigate the clinical significance of coronary ostial stenosis, we reviewed eight patients with such lesions, including three with isolated stenosis at the orifice of the coronary artery. There were five male and three female patients, with an average age of 46.25 years (range 32-69 years). Their symptoms consisted mainly of angina (6 patients), with dyspnoea and palpitation being the presenting features in the remaining two patients. All patients underwent preoperative coronary angiography which confirmed stenosis at the level of the orifice with absence of reflux of contrast medium into the sinus of Valsalva as the main features. Delay in the appreciation of stenosis of the orifice of the right coronary artery resulted in the death of two patients, whose diagnosis was confirmed at post mortem examinations. Stenosis of the orifice of the right coronary artery was present in seven patients, with two patients also having stenosis of the orifice of the left coronary artery. The remaining patient had isolated stenosis of the left coronary arterial orifice. Coronary artery bypass grafting was performed in five patients, including two who had patch angioplasty to the right coronary artery. The patient with isolated stenosis of the orifice of the left coronary artery had patch angioplasty only. Follow-up of up to three years in the surviving patients showed good functional results. The ease with which it is possible to miss right coronary ostial stenosis is emphasized and angiographic features are reviewed.
为了研究冠状动脉开口狭窄的临床意义，我们回顾了8例有此类病变的患者，其中3例为冠状动脉开口孤立性狭窄。患者中男性5例，女性3例，平均年龄46.25岁（范围32 - 69岁）。他们的症状主要为心绞痛（6例），其余2例以呼吸困难和心悸为主要表现。所有患者术前行冠状动脉造影，结果证实主要特征为冠状动脉开口处狭窄且无造影剂反流至主动脉窦。右冠状动脉开口狭窄的诊断延误导致2例患者死亡，尸检证实了诊断。7例患者存在右冠状动脉开口狭窄，其中2例还伴有左冠状动脉开口狭窄。其余1例患者为左冠状动脉开口孤立性狭窄。5例患者接受了冠状动脉旁路移植术，其中2例对右冠状动脉进行了补片血管成形术。左冠状动脉开口孤立性狭窄的患者仅接受了补片血管成形术。存活患者长达3年的随访显示功能结果良好。强调了右冠状动脉开口狭窄易被漏诊的情况，并对血管造影特征进行了回顾。
