Cubero Alain, Crespo Alejandro, Hamzeh Gadah, Cortes Andrés, Rivas Daniel, Aramendi José Ignacio
1 Division of Cardiac Surgery, Cruces University Hospital, Barakaldo, Spain.
World J Pediatr Congenit Heart Surg. 2017 May;8(3):315-320. doi: 10.1177/2150135116688172.
Anomalous aortic origin of a coronary artery is uncommon but potentially clinically significant. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, heart failure, syncope, arrhythmias, and sudden death. We describe our experience with surgical reimplantation and results at midterm follow-up.
Between February 2003 and July 2016, a total of 13 patients with anomalous origin of the right coronary artery (RCA) from the left sinus underwent surgical reimplantation.
Mean age was 39 years (range, 11-72 years). Eight patients presented with dyspnea and angina, two with acute myocardial infarction, and the remaining three were studied for atypical chest pain and ventricular premature contractions. Definitive diagnosis was achieved with coronary angiography in eight cases and with computed tomography scan in five. In all cases, the anomalous origin of the RCA from the left sinus had an intramural course except one case with interarterial (but not intramural) course. At operation, the RCA was dissected at the takeoff from the intramural course and reimplanted into the right sinus of Valsalva. There was no mortality. One patient had associated atherosclerotic coronary artery disease that required stent placement postoperatively. After a mean follow-up of 65 months (maximum 12 years), all patients are asymptomatic and have returned to exercise without limitations.
The reimplantation technique provides a good physiological and anatomical repair, eliminates a slit-like ostium, avoids compression of the coronary artery between the aorta and the pulmonary artery, and gives similar results to the unroofing technique.
冠状动脉异常起源于主动脉较为罕见，但具有潜在的临床意义。其表现从无症状患者到出现心绞痛、心肌梗死、心力衰竭、晕厥、心律失常和猝死的患者不等。我们描述了手术再植入的经验及中期随访结果。
2003年2月至2016年7月期间，共有13例右冠状动脉（RCA）起源于左窦的患者接受了手术再植入。
平均年龄为39岁（范围11 - 72岁）。8例患者表现为呼吸困难和心绞痛，2例为急性心肌梗死，其余3例因非典型胸痛和室性早搏接受检查。8例通过冠状动脉造影确诊，5例通过计算机断层扫描确诊。在所有病例中，除1例为动脉间（而非壁内）走行外，RCA从左窦的异常起源均为壁内走行。手术时，RCA在从壁内走行处起始部进行解剖，并重新植入主动脉瓣窦右窦。无死亡病例。1例患者合并动脉粥样硬化性冠状动脉疾病，术后需要放置支架。平均随访65个月（最长12年）后，所有患者均无症状，已恢复不受限制的运动。
再植入技术提供了良好的生理和解剖修复，消除了裂隙样开口，避免了冠状动脉在主动脉和肺动脉之间受到压迫，其结果与开窗技术相似。
