Naito H, Yorozu T, Maeda T, Shiomi K, Seki K, Tanabe Y, Tada T, Nakashima H
Division of Internal Medicine, Saiseikai Yamaguchi General Hospital.
J Cardiol. 1990;20(2):499-508.
This report presented evidence of myocardial ischemia as the etiology of angina pectoris in three patients with congenital anomalies of the coronary arteries but without arteriosclerotic disease. All of three cases showed angina pectoris and ST depressions on their exercise electrocardiogram. Case 1: This 58-year-old man developed angina pectoris at the age of 50 years. His treadmill exercise test precipitated chest pain and ST depression. His coronary arteriograms disclosed an ectopic origin of the right coronary artery just anterior to the origin of the left coronary artery in the left coronary sinus. No significant atherosclerotic stenosis was present. An apparent ischemic manifestation appeared to be caused by compression of an aberrant right coronary artery between the aorta and the right ventricular infundibulum. Case 2: A 49-year-old woman had a history of angina. Her treadmill exercise test induced chest pain and an abnormal exercise electrocardiographic finding. Her coronary arteriograms revealed a single left coronary artery. Insufficient perfusion was postulated as a cause of apparent myocardial ischemia in this case though angiographically, there was adequate perfusion. Case 3: This 31-year-old man had a six-year history of angina. His treadmill exercise electrocardiograms revealed ischemic changes accompanied by chest pain. Coronary arteriograms disclosed a coronary artery fistula. The ischemic manifestation was apparently caused by inadequate perfusion due to coronary steal. With the increasing use of coronary arteriography, unusual origins and courses of coronary arteries will be more frequently encountered. Precise knowledge of anomalies is prerequisite for evaluating variations in the location of the coronary artery ostia and their statistical probabilities.
本报告提供了证据，证明在3例患有冠状动脉先天性异常但无动脉粥样硬化疾病的患者中，心肌缺血是心绞痛的病因。所有3例患者在运动心电图上均显示心绞痛和ST段压低。病例1：这名58岁男性在50岁时出现心绞痛。他的平板运动试验诱发了胸痛和ST段压低。他的冠状动脉造影显示右冠状动脉异位起源于左冠状动脉窦内左冠状动脉起源的前方。不存在明显的动脉粥样硬化狭窄。明显的缺血表现似乎是由异常的右冠状动脉在主动脉和右心室漏斗部之间受压所致。病例2：一名49岁女性有心绞痛病史。她的平板运动试验诱发了胸痛和异常的运动心电图表现。她的冠状动脉造影显示为单支左冠状动脉。尽管血管造影显示灌注充足，但推测灌注不足是该病例中明显心肌缺血的原因。病例3：这名31岁男性有心绞痛病史6年。他的平板运动心电图显示缺血性改变并伴有胸痛。冠状动脉造影显示冠状动脉瘘。缺血表现显然是由冠状动脉窃血导致的灌注不足引起的。随着冠状动脉造影术的使用增加，冠状动脉的异常起源和走行将更频繁地被发现。准确了解这些异常情况是评估冠状动脉开口位置变化及其统计概率的先决条件。
