Torigoe Tsukasa, Sato Seiichi, Kikuchi Chizuo, Kanazawa Hiroshi
Department of Pediatrics, Niigata City General Hospital, Niigata, Japan.
Congenit Heart Dis. 2014 Jan-Feb;9(1):E1-5. doi: 10.1111/chd.12045. Epub 2013 Mar 1.
This is the first report of a coronary artery with an anomalous origin from the proper sinus resulting in ischemic events in a child. Transthoracic echocardiogram, computed tomogram, and coronary angiogram revealed that, although the left main coronary trunk originated from the left sinus, its ostium was displaced horizontally and was located near the commissure between the left and noncoronary valve cusps. Moreover, it was associated with an acute take off angle and an intramural segment, which are known contributing features for ischemia in cases of anomalous origin of a coronary artery from the wrong sinus. Surgical intervention, involving the unroofing procedure, was employed successfully to eliminate the ischemic events. At the latest follow up, no chest pain was reported and the transthoracic echocardiogram showed no stenosis of the neo-ostium. Even in a coronary artery that originates from the proper sinus, an abnormal ostial location could be associated with an acute takeoff angle and an intramural segment. This finding is extremely rare but entails the risk of ischemia and sudden death.
这是首例关于一名儿童因冠状动脉起源于正常窦而导致缺血事件的报告。经胸超声心动图、计算机断层扫描和冠状动脉造影显示，尽管左冠状动脉主干起源于左窦，但其开口水平移位，位于左冠状动脉瓣叶与无冠状动脉瓣叶交界处附近。此外，它还伴有急性起始角度和壁内段，这是冠状动脉起源于错误窦时已知的导致缺血的特征。采用包括开窗手术在内的手术干预成功消除了缺血事件。在最近的随访中，未报告胸痛，经胸超声心动图显示新开口无狭窄。即使在起源于正常窦的冠状动脉中，开口位置异常也可能与急性起始角度和壁内段有关。这一发现极为罕见，但存在缺血和猝死风险。
