Montigny M, Stanley P, Chartrand C, Selman E, Fournier A, Davignon A
Department of Cardiology, Sainte-Justine Hospital, University of Montreal, Quebec, Canada.
J Thorac Cardiovasc Surg. 1990 Aug;100(2):270-3.
In most instances of anomalous left coronary artery originating from the pulmonary artery, surgical treatment is recommended. Because establishment of a direct systemic to coronary blood flow is expected to provide the best recovery of left ventricular function, various corrective procedures have been proposed. Subclavian-left coronary artery anastomosis appears to be a logical approach. Four patients operated on at Sainte-Justine Hospital, at an average age of 33 months (27 to 44), with an end-to-end subclavian-left coronary artery anastomosis were evaluated 6 to 46 months postoperatively. The anastomosis was patent in all cases. End-diastolic volume index (74.6 +/- 24.7 versus 122.7 +/- 15.3 ml/m2) and ejection fraction (0.58 +/- 0.07 versus 0.33 +/- 0.06) were improved significantly. Subclavian-left coronary artery anastomosis appears to meet the main criteria for an optimal physiologic correction of anomalous left coronary artery: restoration of a two-coronary artery system, improvement of left ventricular function, and likelihood of long-term patency.
在大多数左冠状动脉起源于肺动脉的病例中，建议进行手术治疗。由于建立直接的体循环至冠状动脉血流有望使左心室功能得到最佳恢复，因此人们提出了各种矫正手术。锁骨下动脉 - 左冠状动脉吻合术似乎是一种合理的方法。对在圣朱斯汀医院接受手术的4例患者进行了评估，这些患者平均年龄为33个月（27至44个月），采用锁骨下动脉 - 左冠状动脉端端吻合术，术后6至46个月进行随访。所有病例的吻合口均通畅。舒张末期容积指数（分别为74.6±24.7与122.7±15.3 ml/m²）和射血分数（分别为0.58±0.07与0.33±0.06）均有显著改善。锁骨下动脉 - 左冠状动脉吻合术似乎符合左冠状动脉异常最佳生理矫正的主要标准：恢复双冠状动脉系统、改善左心室功能以及长期通畅的可能性。
