King Nina-Marie, Tian David D, Munkholm-Larsen Stine, Buttar Sana N, Chow Vincent, Yan Tristan
Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Royal North Shore Hospital, Sydney, NSW, Australia; Collaborative Research (CORE) Group, Macquarie University, Sydney, NSW, Australia.
Heart Lung Circ. 2018 Jun;27(6):702-707. doi: 10.1016/j.hlc.2017.06.719. Epub 2017 Jul 3.
An aberrant coronary artery is a rare clinical occurrence with an incidence of 0.05-1.2%. Often it is an incidental finding detected on coronary angiography or at autopsy. However, symptomatic patients can experience angina, arrhythmia, sudden death or non-specific symptoms such as dyspnoea and syncope. At present, there are no guidelines or dedicated studies assessing the treatment of an aberrant coronary artery leaving management options for these patients controversial.
Selected international cardiothoracic surgeons were surveyed electronically in November 2016 to determine whether consensus exists on different management aspects for patients with an aberrant coronary artery arising from the contralateral sinus with an interarterial course.
For asymptomatic patients with either an aberrant left main coronary artery (ALMCA) arising from the contralateral sinus or an aberrant right main coronary artery (ARMCA) arising from the contralateral sinus, there was no consensus on surgical correction of the anomaly. If myocardial ischaemia was demonstrated on either coronary angiography with fractional flow reserve measurements and/or stress myocardial perfusion scan, surgical correction was the consensus between the surveyed surgeons. If surgery was deemed appropriate, coronary artery bypass surgery utilising the internal mammary artery was marginally preferred by the respondents in patients with an ALMCA whilst unroofing of the coronary ostium was preferred in patients with an ARMCA. Although no consensus was reached, a large proportion of respondents would not treat a patient over the age of 30 years differently compared to those under 30 years old.
For symptomatic patients or if myocardial ischaemia is demonstrated on either coronary angiography with fractional flow reserve measurements and/or stress myocardial perfusion scan, surgical correction is indicated.
冠状动脉异常是一种罕见的临床情况，发病率为0.05 - 1.2%。通常是在冠状动脉造影或尸检时偶然发现。然而，有症状的患者可能会出现心绞痛、心律失常、猝死或非特异性症状，如呼吸困难和晕厥。目前，尚无评估冠状动脉异常治疗的指南或专门研究，这使得这些患者的管理选择存在争议。
2016年11月对选定的国际心胸外科医生进行了电子调查，以确定对于起源于对侧窦且走行于动脉间的冠状动脉异常患者，在不同管理方面是否存在共识。
对于起源于对侧窦的异常左主冠状动脉（ALMCA）或异常右主冠状动脉（ARMCA）的无症状患者，对于该异常的手术矫正没有达成共识。如果在冠状动脉造影结合血流储备分数测量和/或负荷心肌灌注扫描中显示心肌缺血，手术矫正是受访外科医生之间的共识。如果认为手术合适，对于ALMCA患者，受访者略倾向于使用乳内动脉进行冠状动脉旁路移植术，而对于ARMCA患者，则倾向于冠状动脉开口开窗术。尽管未达成共识，但很大一部分受访者对30岁以上患者与30岁以下患者的治疗方式没有区别。
对于有症状的患者，或在冠状动脉造影结合血流储备分数测量和/或负荷心肌灌注扫描中显示心肌缺血的患者，应进行手术矫正。
