Agrawal Hitesh, Molossi Silvana, Alam Mahboob, Sexson-Tejtel S Kristen, Mery Carlos M, McKenzie E Dean, Fraser Charles D, Qureshi Athar M
Coronary Anomalies Program, Texas Children's Hospital, Houston, TX, USA.
The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
Pediatr Cardiol. 2017 Mar;38(3):624-630. doi: 10.1007/s00246-016-1559-4. Epub 2017 Feb 18.
The evaluation of the vast majority of children with anomalous aortic origin of a coronary artery (AAOCA) and/or myocardial bridges is performed with non-invasive testing. However, a subset of these patients may benefit from invasive testing for risk stratification. All patients included in the Coronary Anomalies Program (CAP) at Texas Children's Hospital who underwent cardiac catheterization were included. Techniques included selective coronary angiograms (SCA), intravascular ultrasound (IVUS), and fractional flow reserve (FFR) measurements with provocative testing using adenosine and/or dobutamine infusions. Out of the 131 patients followed by the CAP between 12/12-4/16, 8 (6%) patients underwent 9 cath investigations at median age 13.1 (2.6-18.7) years and median weight 49.5 (11.4-142.7) kg. Six patients presented with cardiac signs/symptoms. Four patients had myocardial bridges of the left anterior descending (LAD) coronary artery, 2 patients had isolated AAOCA, and 2 patients had an anomalous left coronary artery (LCA) with an intramyocardial course of the LAD. SCA was performed in all patients. FFR was positive in 4/6 patients: IVUS showed >70% intraluminal narrowing in 3/5 patients. One patient had hemodynamic instability that reversed with catheter removal from the coronary ostium. Based on the catheterization data obtained, findings were reassuring in three patients, surgery was performed in three patients, and two patients are being medically managed/restricted from competitive sports. In our small cohort of patients, we demonstrated that IVUS and FFR can safely be performed in children and may help to risk stratify some patients with AAOCA and myocardial bridges.
绝大多数冠状动脉异常起源（AAOCA）和/或心肌桥患儿的评估是通过无创检查进行的。然而，这些患者中的一部分可能会从有创检查中受益，以进行风险分层。纳入了德克萨斯儿童医院冠状动脉异常项目（CAP）中所有接受心脏导管插入术的患者。技术包括选择性冠状动脉造影（SCA）、血管内超声（IVUS）以及使用腺苷和/或多巴酚丁胺输注进行激发试验的血流储备分数（FFR）测量。在12/12 - 4/16期间CAP随访的131例患者中，8例（6%）患者在中位年龄13.1（2.6 - 18.7）岁、中位体重49.5（11.4 - 142.7）kg时接受了9次导管检查。6例患者有心脏体征/症状。4例患者有左前降支（LAD）冠状动脉心肌桥，2例患者有孤立性AAOCA，2例患者有异常左冠状动脉（LCA）且LAD走行于心肌内。所有患者均进行了SCA。4/6例患者FFR为阳性：3/5例患者IVUS显示管腔内狭窄>70%。1例患者出现血流动力学不稳定，在将导管从冠状动脉口移除后逆转。根据获得的导管检查数据，3例患者的检查结果令人放心，3例患者接受了手术，2例患者正在接受药物治疗/被限制参加竞技运动。在我们这一小群患者中，我们证明了IVUS和FFR可以在儿童中安全进行，并且可能有助于对一些AAOCA和心肌桥患者进行风险分层。
