经皮冠状动脉成形术治疗左主干冠状动脉开口先天性闭锁。
Coronary ostioplasty for congenital atresia of the left main coronary artery ostium.
机构信息
Division of Cardiothoracic Surgery, Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
出版信息
Ann Thorac Surg. 2012 Oct;94(4):1307-10. doi: 10.1016/j.athoracsur.2012.04.072. Epub 2012 Jul 25.
BACKGROUND
Coronary ostial atresia is a rare anomaly, most frequently managed with coronary artery bypass grafting. This condition is often misdiagnosed as anomalous left coronary artery from the pulmonary artery until the time of surgical intervention, leaving the surgeon little time to contemplate the best operative technique.
METHODS
In this single-center experience, three cases of congenital atresia of the left main coronary artery presenting during childhood were surgically managed with homograft patch ostioplasty.
RESULTS
Antegrade left coronary artery blood flow was successfully established in all three cases without the use of a bypass graft. Two children survived and are clinically well; the third had visibly necrotic myocardium at the time of surgical ostioplasty and did not survive to hospital discharge.
CONCLUSIONS
Surgical ostioplasty with a homograft patch should be considered as an alternative to bypass grafting for coronary ostial atresia in children.
背景
冠状动脉开口闭锁是一种罕见的异常情况，大多数情况下通过冠状动脉旁路移植术进行治疗。这种情况经常被误诊为肺动脉起源的左冠状动脉异常，直到手术干预时才发现，这使得外科医生几乎没有时间考虑最佳的手术技术。
方法
在本单中心经验中，3 例儿童时期出现的先天性左主干冠状动脉闭锁通过同种异体移植物补片成形术进行了手术治疗。
结果
所有 3 例患者均成功建立了顺行性左冠状动脉血流，未使用旁路移植术。2 例患儿存活且临床情况良好；第 3 例患儿在手术成形术时可见明显的心肌坏死，未能存活至出院。
结论
对于儿童冠状动脉开口闭锁，同种异体移植物补片成形术应被视为旁路移植术的替代方法。
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