Marler Adam T, Malik Jamil A, Slim Ahmad M
Cardiology Service, San Antonio Military Medical Center, Fort Sam Houston, TX 78234, USA.
Case Rep Vasc Med. 2013;2013:380952. doi: 10.1155/2013/380952. Epub 2013 Dec 22.
Background. Congenital anomalies of the coronary arteries are a cause of sudden cardiac death. Of the known anatomic variants, anomalous origination of a coronary artery from an opposite sinus of Valsalva (ACAOS) remains the main focus of debate. Case Series. We present three cases, all presenting to our facility within one week's time, of patients with newly discovered anomalous origination of the left coronary artery from the right sinus of Valsalva (L-ACAOS). All patients underwent cardiac computed tomography for evaluation of coronary anatomy along with other forms of functional testing. Despite the high risk nature of two of the anomalies, the patients are being treated medically without recurrence of symptoms. Summary. After review of the literature, we have found that the risk of sudden cardiac death in patients with congenital coronary anomalies, even among variants considered the highest risk, may be overestimated. In addition, the exact prevalence of coronary anomalies in the general population is currently underestimated. A national coronary artery anomaly registry based on cardiac computed tomography and invasive coronary angiography data would be helpful in advancing our understanding of these cardiac peculiarities. The true prevalence of congenital coronary anomalies and overall risk of sudden cardiac death in this population are not well known. Surgical intervention remains the mainstay of therapy in certain patients though recent investigations into the pathophysiology of these abnormalities have shown that the risk of surgery may outweigh the minimal reduction in risk of sudden cardiac death.
背景。冠状动脉先天性异常是心源性猝死的一个原因。在已知的解剖变异中，冠状动脉起源于对侧瓦尔萨尔瓦窦（ACAOS）仍然是争论的主要焦点。病例系列。我们报告三例病例，均在一周内就诊于我院，均为新发现的左冠状动脉起源于右瓦尔萨尔瓦窦（L - ACAOS）。所有患者均接受了心脏计算机断层扫描以评估冠状动脉解剖结构以及其他形式的功能测试。尽管其中两例异常具有高风险性质，但患者接受药物治疗后症状未复发。总结。在查阅文献后，我们发现先天性冠状动脉异常患者的心源性猝死风险，即使在被认为是最高风险的变异中，可能也被高估了。此外，目前一般人群中冠状动脉异常的确切患病率被低估了。基于心脏计算机断层扫描和有创冠状动脉造影数据建立的全国性冠状动脉异常登记册将有助于增进我们对这些心脏特殊情况的了解。该人群中先天性冠状动脉异常的真实患病率和心源性猝死的总体风险尚不清楚。手术干预仍然是某些患者治疗的主要手段，尽管最近对这些异常病理生理学的研究表明，手术风险可能超过心源性猝死风险的最小降低。
