Turner Immanuel I, Turek Joseph W, Jaggers James, Herlong J Rene, Lawson Dale S, Lodge Andrew J
Pediatric Cardiac Surgery, Duke University Medical Center, Durham, NC, USA.
World J Pediatr Congenit Heart Surg. 2011 Jul 1;2(3):340-5. doi: 10.1177/2150135111406938.
Anomalous aortic origin of a coronary artery (AAOCA), the anomalous coronary artery arises from an inappropriate coronary sinus and travels between the aorta and pulmonary artery. Proper surgical management depends upon correct diagnosis and accurate characterization of the origin and course of the coronary artery. Transthoracic echocardiography (TTE) has been the mainstay for diagnosis, but magnetic resonance imaging (MRI) and computed tomographic angiography (CTA) have been increasingly utilized. In this study, we report the largest series of surgically repaired AAOCA and accuracy of preoperative diagnostic studies.
A review of 53 consecutive patients (mean age 13.9 years, range 4-65 years) undergoing repair of an AAOCA from 1995 to 2009 was performed. In all, 40 patients were identified with an anomalous right coronary artery (ARCA) from the left sinus of Valsalva, 13 patients had an anomalous left coronary artery (ALCA) arising from the opposite sinus. Symptoms of angina or syncope were present in 58% and 46% of cases with ARCA and ALCA, respectively. RESULTS of preoperative diagnostic testing were compared to actual surgical findings to determine the accuracy of the tests.
Lack of an intramural course was observed intraoperatively in 7 cases (5 ARCA and 2 ALCA). Preoperative TTE accurately predicted whether the AAOCA was intramural or extramural in 49 (92.5%) of 53 cases. Magnetic resonance imaging was predictive in 5 (83.3%) of 6 patients and CTA in 11 (64.7%) of 17. Survival was 100%. Complications occurred in 4 (7.5%) of 53 patients (mean follow-up 29 months). Patency was confirmed in 97.7% with TTE, and 23 (95.8%) of 24 patients had a negative postoperative functional study.
Transthoracic echocardiography was found to be very accurate at defining the presence or absence of an intramural course in AAOCA. Both MRI and CTA can provide additional information but may not be as accurate as TTE.
冠状动脉异常起源（AAOCA），即异常冠状动脉起源于不适当的冠状窦，并走行于主动脉和肺动脉之间。恰当的手术治疗取决于冠状动脉起源和走行的正确诊断及准确特征描述。经胸超声心动图（TTE）一直是诊断的主要手段，但磁共振成像（MRI）和计算机断层血管造影（CTA）的应用也越来越多。在本研究中，我们报告了接受手术修复的AAOCA的最大系列病例以及术前诊断性检查的准确性。
对1995年至2009年连续53例接受AAOCA修复的患者（平均年龄13.9岁，范围4 - 65岁）进行回顾性研究。其中，40例患者被确诊为右冠状动脉异常（ARCA）起源于左冠窦，13例患者左冠状动脉异常（ALCA）起源于对侧窦。ARCA和ALCA病例中分别有58%和46%出现心绞痛或晕厥症状。将术前诊断性检查结果与实际手术发现进行比较，以确定检查的准确性。
术中观察到7例（5例ARCA和2例ALCA）无壁内走行。术前TTE在53例中的49例（92.5%）中准确预测了AAOCA是壁内还是壁外走行。磁共振成像在6例患者中的5例（83.3%）具有预测性，CTA在17例中的11例（64.7%）具有预测性。生存率为100%。53例患者中有4例（7.5%）发生并发症（平均随访29个月）。TTE证实通畅率为97.7%，24例患者中有23例（95.8%）术后功能检查结果为阴性。
发现经胸超声心动图在确定AAOCA壁内走行的有无方面非常准确。MRI和CTA都可以提供额外信息，但可能不如TTE准确。
