Tsuchiya K, Arakaki Y, Takahashi O, Kamiya T, Kimura K, Yagihara T
Department of Pediatrics, National Cardiovascular Center, Suita.
J Cardiol. 1989 Mar;19(1):333-40.
A two-month-old boy with anomalous origin of the left anterior descending coronary artery (AOLAD), aortic stenosis (AS), coarctation of the aorta (CoA) and patent ductus arteriosus (PDA) is reported. Tachypnea was observed since birth. When he arrived at our hospital, congestive heart failure, cyanosis of his lower extremities and weak femoral pulses were observed. Radiography revealed cardiomegaly and pulmonary congestion. ECG showed low voltage in all leads, ST elevation in leads II, aVF, V5,6 and abnormal Q waves in V5,6. The tentative diagnosis by two-dimensional echocardiography (2DE) was AS, CoA, PDA, pulmonary hypertension and pericardial effusion. The abnormal coronary artery was visualized as originating from the left anterior wall of the pulmonary artery, coursing between the pulmonary artery and left atrial appendage. A definitive diagnosis of AOLAD were made by angiography. Aortic reconstruction using an artificial graft for CoA and PDA ligation was performed first. He died of myocardial infarction while waiting for his second operation for AOLAD and AS. Autopsy confirmed the aforementioned diagnoses as well as old and recent infarction of the myocardium. AOLAD is a rare congenital malformation, only six cases of which have been reported. Moreover, AOLAD complicated by other anomalies had not been previously reported. This is the first such reported case.
本文报道了一名两个月大的男婴，患有左前降支冠状动脉异常起源（AOLAD）、主动脉狭窄（AS）、主动脉缩窄（CoA）和动脉导管未闭（PDA）。自出生以来观察到呼吸急促。当他到达我院时，观察到充血性心力衰竭、下肢发绀和股动脉搏动微弱。X线检查显示心脏增大和肺充血。心电图显示所有导联低电压，II、aVF、V5、6导联ST段抬高，V5、6导联出现异常Q波。二维超声心动图（2DE）初步诊断为AS、CoA、PDA、肺动脉高压和心包积液。异常冠状动脉显示起源于肺动脉左前壁，走行于肺动脉和左心耳之间。通过血管造影确诊为AOLAD。首先使用人工移植物进行主动脉重建以治疗CoA，并结扎PDA。他在等待AOLAD和AS的第二次手术时死于心肌梗死。尸检证实了上述诊断以及心肌的陈旧性和近期梗死。AOLAD是一种罕见的先天性畸形，此前仅报道过6例。此外，此前尚未报道过AOLAD合并其他畸形的病例。这是首例此类报道病例。
