Shinbane Jerold S, Shriki Jabi, Fleischman Fernando, Hindoyan Antreas, Withey James, Lee Christopher, Wilcox Alison, Cunningham Mark, Baker Craig, Matthews Ray V, Starnes Vaughn
Division of Cardiovascular Medicine/Cardiovascular and Thoracic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
World J Pediatr Congenit Heart Surg. 2013 Apr;4(2):142-54. doi: 10.1177/2150135112474027.
Cardiovascular computed tomographic angiography (CCTA) provides an understanding of the three-dimensional (3D) coronary artery anatomy in relation to cardiovascular thoracic structures important to the surgical management of anomalous coronary arteries (ACAs). Although some ACA variants are not clinically significant, others can lead to ischemia/infarction, related acute ventricular dysfunction, ventricular arrhythmias, and sudden cardiac death. The CCTA is important to surgical decision making, as it provides noninvasive visualization of the coronary arteries with (1) assessment of origin, course, and termination of coronary artery anomalies in the context of 3D thoracic anatomy, (2) characterization of anatomy helpful for differentiation of benign versus hemodynamically significant variants, (3) identification of other cardiothoracic anomalies, and (4) detection of coronary artery disease. High-risk ACA anatomy in the appropriate clinical setting can require surgical intervention with decisions including minimally invasive versus open sternotomy approach, correction via reimplantation of a coronary artery, alteration of the ACA course without reimplantation, or bypass of an ACA. Given the rarity of ACA, there is limited data in the literature, and significant controversy related to the management issues. The management of ACA requires comprehensive clinical history, thorough assessment of cardiac function, and detailed anatomic imaging. Future studies will need to address the long-term outcome based on detailed assessment of original anatomy and surgical approach.
心血管计算机断层血管造影（CCTA）有助于了解三维（3D）冠状动脉解剖结构，以及与异常冠状动脉（ACA）外科治疗相关的心血管胸部结构。虽然一些ACA变异在临床上无显著意义，但其他变异可导致缺血/梗死、相关的急性心室功能障碍、室性心律失常和心源性猝死。CCTA对手术决策很重要，因为它能无创地显示冠状动脉，包括：（1）在3D胸部解剖结构背景下评估冠状动脉异常的起源、走行和终止；（2）有助于区分良性与血流动力学显著变异的解剖特征；（3）识别其他心胸异常；（4）检测冠状动脉疾病。在适当的临床情况下，高危ACA解剖结构可能需要手术干预，决策包括微创与开胸手术入路、通过冠状动脉再植进行矫正、在不进行再植的情况下改变ACA走行或绕过ACA。鉴于ACA较为罕见，文献中的数据有限，且在管理问题上存在重大争议。ACA的管理需要全面的临床病史、对心脏功能的彻底评估以及详细的解剖成像。未来的研究需要基于对原始解剖结构和手术方法的详细评估来探讨长期结果。
