Cho Sang-Ho, Joo Hyun-Chel, Yoo Kyung-Jong, Youn Young-Nam
Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea.
Thorac Cardiovasc Surg. 2015 Aug;63(5):360-6. doi: 10.1055/s-0034-1376256. Epub 2014 Jun 9.
Anomalous aortic origin of coronary artery is a rare congenital condition in which the coronary artery arises from the opposite sinus of Valsalva. Although many patients are asymptomatic at the time of presentation or diagnosis, surgical correction is recommended due to the risk of ischemic sudden death. We describe seven cases of right coronary artery (RCA) arising from the left sinus of Valsalva, causing the hypoperfusion through RCA.
All patients underwent preoperative coronary angiography, echocardiography, and cardiac stress test (treadmill test [TMT], n = 4; technetium-99m sestamibi [MIBI], n = 3). In four patients, coronary computed tomography (CT) was performed. On the basis of preoperative test results, unroofing of the coronary artery (n = 3) or off-pump coronary artery bypass (OPCAB; n = 4; patients with coronary arterial occlusive disease) was performed. In two patients, intraoperative flow meter was performed and showed the improvement of flow rate through RCA.
Postoperative CT angiography after OPCAB confirmed good graft patency (n = 4); CT angiography after unroofing demonstrated widely patent neo-orifice (n = 3). All patients underwent postoperative cardiac stress tests including TMT and MIBI, which revealed no evidence of ischemia. All patients were asymptomatic and returned to normal activities (mean follow-up, 41 months; 32-49 months).
The appropriate surgical procedure based on specific anatomical details, perioperative evaluation, and follow-up by focusing on the ischemia may lead to successful surgical outcomes of this coronary anomaly.
冠状动脉异常起源是一种罕见的先天性疾病，即冠状动脉起源于对侧的瓦尔萨尔瓦窦。尽管许多患者在就诊或诊断时无症状，但由于存在缺血性猝死风险，仍建议进行手术矫正。我们描述了7例右冠状动脉（RCA）起源于左瓦尔萨尔瓦窦并导致RCA灌注不足的病例。
所有患者均接受了术前冠状动脉造影、超声心动图和心脏负荷试验（平板运动试验[TMT]，4例；锝-99m甲氧基异丁基异腈[MIBI]，3例）。4例患者进行了冠状动脉计算机断层扫描（CT）。根据术前检查结果，进行了冠状动脉开窗术（3例）或非体外循环冠状动脉搭桥术（OPCAB；4例；患有冠状动脉闭塞性疾病的患者）。2例患者术中使用了流量计，显示RCA血流速度有所改善。
OPCAB术后的CT血管造影证实移植血管通畅良好（4例）；开窗术后的CT血管造影显示新开口广泛通畅（3例）。所有患者术后均接受了包括TMT和MIBI在内的心脏负荷试验，未发现缺血证据。所有患者均无症状，恢复了正常活动（平均随访41个月；32 - 49个月）。
基于特定解剖细节、围手术期评估以及关注缺血情况进行的适当手术操作，可能会使这种冠状动脉异常获得成功的手术结果。
