Loukas Marios, Andall Rebecca G, Khan Akbar Z, Patel Kush, Muresian Horia, Spicer Diane E, Tubbs R Shane
Department of Anatomical Sciences, St. George's University, School of Medicine Grenada, West Indies.
Department of Cardiovascular Surgery, The University Hospital of Bucharest, Romania.
Clin Anat. 2016 Apr;29(3):408-19. doi: 10.1002/ca.22664. Epub 2015 Nov 18.
A number of criteria are used in the literature to describe high take-off coronary arteries, which can in part, explain the divide in the literature on the pathological significance of this anomaly. This study presents the anatomical variations of high take-off coronary arteries to draw attention to the possible clinical implications they may cause during angiography and other surgical procedures. The English Literature was searched to review high take-off coronary arteries. A high take-off coronary artery arising at least 1 cm in adults or 20% the depth of the sinus in children above the sinutubular junction, is considered of greater clinical relevance and was included in our meta-analysis. High take-off coronaries by other criteria was also included as part of the comprehensive review. Exclusion criteria were reports made in case studies or case reviews. The prevalence of high take-off coronary arteries in our study was 26 of 12,899 (0.202%). High take-off coronary arteries were found to originate up to 5 cm above the sinutubular junction. Right coronary arteries made up 84.46% of high take-off coronary arteries reported in the literature. Three (0.023%) cases that originated more than one centimeter above the sinutubular junction was associated with sudden cardiac death. This is a higher reported association than in studies that used other criteria for classification. It is important for clinicians to recognize the importance of correctly diagnosing high take-off coronary arteries in patients with coexisting cardiac morbidities so that suitable management plans can be developed.
文献中使用了多种标准来描述高位起始冠状动脉，这在一定程度上可以解释关于这种异常病理意义的文献分歧。本研究展示了高位起始冠状动脉的解剖变异，以引起人们对其在血管造影和其他外科手术过程中可能产生的临床影响的关注。检索英文文献以回顾高位起始冠状动脉。在成人中，冠状动脉起始于窦管交界上方至少1厘米处，或在儿童中起始于窦深度的20%以上，被认为具有更大的临床相关性，并纳入我们的荟萃分析。其他标准定义的高位起始冠状动脉也作为综合综述的一部分被纳入。排除标准为病例研究或病例回顾报告。在我们的研究中，高位起始冠状动脉的患病率为12899例中的26例（0.202%）。发现高位起始冠状动脉可起源于窦管交界上方达5厘米处。右冠状动脉占文献报道的高位起始冠状动脉的84.46%。在窦管交界上方1厘米以上起源的3例（0.023%）与心源性猝死相关。这一报道的关联高于使用其他分类标准的研究。临床医生认识到正确诊断合并心脏疾病患者的高位起始冠状动脉的重要性很重要，以便制定合适的管理计划。
