Green Michael Stuart, Sehgal Sankalp, Smukler Naomi, Suber LaDouglas Jarod, Saththasivam Pooven
Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, PA, USA
Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, PA, USA.
Semin Cardiothorac Vasc Anesth. 2016 Sep;20(3):232-6. doi: 10.1177/1089253215605389. Epub 2015 Sep 10.
The anatomy of the coronary circulation is well described with incidence of congenital anomalies of approximately 0.3% to 1.0%. Although often incidental, 20% are life-threatening. A 25-year-old woman with syncopal episodes collapsed following a 10-km run. Coronary anatomy evaluation showed an anomalous left main coronary artery originating from the right sinus of valsalva and following a course between the aorta and the pulmonary outflow tract. Percutaneous coronary intervention was followed by eventual surgical revascularization. Abnormal course of coronary arteries plays a role in the pathogenesis of sudden death on exertion. Origin of the left main coronary from the right sinus of valsalva is a rare congenital anomaly. The expansion of the roots of the aorta and pulmonary trunk with exertion lead to compression of the coronary artery and syncope. Our patient raises awareness of a potentially fatal coronary artery path. Intraoperative identification of anomalous coronaries by utilizing intraoperative transesophageal echocardiography was critical.
冠状动脉循环的解剖结构已有详尽描述，先天性异常的发生率约为0.3%至1.0%。虽然这些异常常常是偶然发现的，但其中20%会危及生命。一名25岁有晕厥发作史的女性在跑完10公里后晕倒。冠状动脉解剖评估显示，一条异常的左主冠状动脉起源于主动脉窦右窦，并走行于主动脉和肺动脉流出道之间。经皮冠状动脉介入治疗后最终进行了外科血运重建。冠状动脉走行异常在运动性猝死的发病机制中起作用。左主冠状动脉起源于主动脉窦右窦是一种罕见的先天性异常。运动时主动脉根部和肺动脉干的扩张导致冠状动脉受压并引发晕厥。我们的患者提高了人们对一种潜在致命性冠状动脉路径的认识。术中利用经食管超声心动图识别异常冠状动脉至关重要。
