Brothers Julie A
Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Congenit Heart Dis. 2017 Sep;12(5):600-602. doi: 10.1111/chd.12497. Epub 2017 Jun 27.
Anomalous aortic origin of a coronary artery (AAOCA) occurs when both coronary arteries arise from the same aortic sinus from a single ostium or two separate ostia. While most coronary anomalies are benign, the two most common subtypes that predispose to sudden cardiac death in the young are interarterial anomalous right coronary artery and interarterial anomalous left coronary artery. Practitioners face many challenges with AAOCA. Diagnosing patients may be difficult because children and adolescents are often asymptomatic and first presentation may be sudden death or sudden cardiac arrest. Risk stratification is also challenging as determining which unique characteristics place the child at highest risk of sudden death has not been adequately delineated and ischemic testing may give false negative results. Last, there is significant variability in decision making regarding management of youth with AAOCA. Future research is needed to help determine the best way to identify at-risk children and which treatment is the safest and most efficacious.
冠状动脉异常起源于主动脉（AAOCA）是指两条冠状动脉均发自同一个主动脉窦的单个开口或两个分开的开口。虽然大多数冠状动脉异常是良性的，但在年轻人中最易导致心源性猝死的两种最常见亚型是动脉间异常右冠状动脉和动脉间异常左冠状动脉。医生在处理AAOCA时面临许多挑战。诊断患者可能很困难，因为儿童和青少年通常没有症状，首次表现可能是猝死或心搏骤停。风险分层也具有挑战性，因为尚未充分阐明哪些独特特征会使儿童处于最高的心源性猝死风险中，而且缺血测试可能会给出假阴性结果。最后，在AAOCA青少年患者的管理决策方面存在很大差异。需要未来的研究来帮助确定识别高危儿童的最佳方法以及哪种治疗是最安全、最有效的。
