Jafra Anudeep, Arora Suman, Jayant Aveek
Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Ann Card Anaesth. 2017 Jul-Sep;20(3):372-375. doi: 10.4103/0971-9784.210402.
Congenital coronary artery anomalies as a whole are uncommon. Abnormal origin of the left coronary artery from the pulmonary artery (ALCAPA) is probably the most common congenital coronary defect. An overwhelming majority of the patients with untreated ALCAPA do not survive to adulthood. As yet, there is no consensus on the management of adults with ALCAPA. We describe a patient with breast malignancy and incidentally detected ALCAPA; primacy was given to treatment of the oncologic condition as a first step. Anesthesia management was focused on maintaining adequate collateral coronary perfusion and avoidance of excessive loading of the left ventricle. This was achieved using a simplified transthoracic echocardiography (TTE) protocol at the time of induction of anesthesia; TTE was also used to reconfirm the absence of disturbances in myocardial function at the end of surgery. We sugggest the routine use of tte in managing perioperative care in low resource settings when the underlying cardiac disease is rare and the evidence base if often insufficient.
先天性冠状动脉异常总体上并不常见。左冠状动脉起源于肺动脉（ALCAPA）可能是最常见的先天性冠状动脉缺陷。绝大多数未经治疗的ALCAPA患者无法存活至成年。迄今为止，对于成年ALCAPA患者的治疗尚无共识。我们描述了一名患有乳腺恶性肿瘤且偶然发现ALCAPA的患者；第一步优先治疗肿瘤疾病。麻醉管理的重点是维持足够的冠状动脉侧支灌注并避免左心室负荷过重。这是通过在麻醉诱导时使用简化的经胸超声心动图（TTE）方案实现的；手术结束时也使用TTE再次确认心肌功能无异常。我们建议，当潜在的心脏疾病罕见且证据基础通常不足时，在资源匮乏地区的围手术期护理管理中常规使用TTE。
