Kheirkhah Jalal, Habibifar Ali, Moladoust Hassan
Cardiovascular Research Center, Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran.
J Tehran Heart Cent. 2014;9(3):135-6. Epub 2014 Jul 3.
Coronary artery anomalies are rare, with their incidence varying from 1 to 5%. Angiography is a commonly used modality for the assessment of coronary artery anomalies. Based on previous reports, a majority of coronary artery anomalies are of origin or distribution, with separate ostia of the left anterior descending artery and left circumflex artery. Coronary artery anomalies may cause myocardial ischemia secondary to atherosclerosis in the same artery. We present a rare case of duplicated right coronary artery with a separate ostium, which caused myocardial ischemia. Our patient was a 51-year-old diabetic woman with typical chest pain and dyspnea on exertion. Electrocardiography showed left axis deviation, poor R progression, and biphasic T wave in the precordial leads. Echocardiography revealed left ventricular ejection fraction of 30-35% and global hypokinesia. Coronary angiography demonstrated three-vessel disease and a double ostial right coronary artery. We recommended coronary artery bypass graft surgery, but the patient refused it and we continued her treatment with anti-ischemic drugs.
冠状动脉异常较为罕见，其发病率在1%至5%之间。血管造影术是评估冠状动脉异常常用的方法。根据以往报道，大多数冠状动脉异常表现为起源或走行异常，左前降支和左旋支有各自独立的开口。冠状动脉异常可能导致同一动脉内继发动脉粥样硬化而引起心肌缺血。我们报告一例罕见的右冠状动脉重复且开口独立的病例，该病例导致了心肌缺血。我们的患者是一名51岁的糖尿病女性，有典型的胸痛症状，且运动时出现呼吸困难。心电图显示电轴左偏、R波递增不良以及胸前导联T波双向。超声心动图显示左心室射血分数为30% - 35%，整体运动减弱。冠状动脉造影显示三支血管病变以及右冠状动脉双开口。我们建议进行冠状动脉搭桥手术，但患者拒绝了，于是我们继续用抗缺血药物对她进行治疗。
