Jung Yochun, Ahn Byoung Hee, Lee Kyo Seon, Jeong In Seok, Oh Sang Gi, Na Kook Joo, Kim Kye Hun
Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea.
Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Hwasun, South Korea.
J Cardiothorac Surg. 2016 Oct 24;11(1):150. doi: 10.1186/s13019-016-0542-8.
The association between the anatomy of a single coronary artery (SCA) and the surgical risk of aortic valve replacement (AVR) remains unclear due to a lack of studies on this topic.
A 73-year-old woman underwent AVR for aortic stenosis. Preoperative coronary angiography results showed a SCA arising from the left coronary sinus. The Manouguian procedure was performed for a small aortic annulus. Intraoperatively, an extracorporeal membrane oxygenator (ECMO) was needed for bypass weaning failure due to newly developed right ventricular dysfunction. Coronary angiography was performed on postoperative day 4, and the findings showed a right coronary artery occlusion just after its origin. After emergent coronary artery bypass surgery, she could be weaned from the ECMO. She was discharged on postoperative day 70 and followed up without complications for 12 months.
AVR with the annular enlargement procedure in those with a SCA can result in an unexpected coronary artery occlusion, which should be, therefore, suspected when unexplained myocardial dysfunction occur. For reducing this risk, the use of a small prosthesis should be considered over the annular enlargement procedure when performing AVR in those with a small aortic annulus and a SCA.
由于缺乏关于单支冠状动脉（SCA）解剖结构与主动脉瓣置换术（AVR）手术风险之间关系的研究，二者之间的关联仍不明确。
一名73岁女性因主动脉瓣狭窄接受了AVR手术。术前冠状动脉造影结果显示一支SCA发自左冠状动脉窦。因主动脉瓣环较小，实施了马努吉安手术。术中，由于新出现的右心室功能障碍，在脱离体外循环失败后需要使用体外膜肺氧合（ECMO）。术后第4天进行了冠状动脉造影，结果显示右冠状动脉在起始处刚发出后即闭塞。紧急冠状动脉搭桥手术后，她成功脱离了ECMO。她于术后第70天出院，并随访12个月无并发症。
对于患有SCA的患者，AVR联合瓣环扩大术可能导致意外的冠状动脉闭塞，因此，当出现无法解释的心肌功能障碍时应怀疑这种情况。为降低这种风险，在对主动脉瓣环较小且患有SCA的患者进行AVR时，应考虑使用小号人工瓣膜而非瓣环扩大术。
