Cohen Meryl S, Herlong René J, Silverman Norman H
Division of Cardiology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, United States of America.
Cardiol Young. 2010 Dec;20 Suppl 3:26-34. doi: 10.1017/S104795111000106X.
In the past, coronary arterial anomalies have been difficult to diagnose by non-invasive methods. Identification of coronary arterial origins is now a routine part of the standard paediatric echocardiogram. Anomalous origin of a coronary artery from the pulmonary trunk is an extremely important diagnosis to make. Many echocardiographic features are not directly related to the visualisation of the coronary arterial origin. Left ventricular dilation and abnormal ventricular performance are common, along with mitral regurgitation and evidence of collateralisation of the flow from the coronary artery that has an aortic origin. In some cases, the anomalous coronary artery can be seen to arise directly from the pulmonary trunk. Congenital atresia of the main stem of the left coronary artery has a similar echocardiographic presentation, except that its aortic origin is not determined. Anomalous aortic origin of the coronary artery has important implications, as the first presenting symptom can be sudden death. With meticulous attention to the origins of the coronary arteries, echocardiographic diagnosis can also be achieved. In contrast to the anomalous origin of a coronary artery from the pulmonary trunk, ventricular performance is usually normal. Whenever there is doubt as to the definition of the origin of the coronary arteries and, indeed, when there is serious clinical concern that a coronary artery has an anomalous origin, other testing, such as cine-computed tomography, magnetic resonance imaging, or cardiac catheterisation may be indicated for confirmation or to provide greater anatomic detail.
过去，冠状动脉异常难以通过非侵入性方法诊断。确定冠状动脉起源现在是标准儿科超声心动图的常规组成部分。冠状动脉起源于肺动脉干是一项极其重要的诊断。许多超声心动图特征与冠状动脉起源的可视化并无直接关联。左心室扩张和心室功能异常很常见，同时伴有二尖瓣反流以及来自主动脉起源冠状动脉的血流侧支循环证据。在某些情况下，可看到异常冠状动脉直接起源于肺动脉干。左冠状动脉主干先天性闭锁有类似的超声心动图表现，只是其主动脉起源无法确定。冠状动脉异常起源于主动脉具有重要意义，因为首发症状可能是猝死。通过仔细关注冠状动脉起源，也可实现超声心动图诊断。与冠状动脉起源于肺动脉干不同，心室功能通常正常。每当对冠状动脉起源的定义存在疑问，以及确实存在严重临床担忧冠状动脉起源异常时，可能需要进行其他检查，如电影计算机断层扫描、磁共振成像或心导管检查以进行确认或提供更详细的解剖细节。
