Koike K, Musewe N N, Smallhorn J F, Freedom R M
Hospital for Sick Children, Department of Pediatrics, University of Toronto, Canada.
Br Heart J. 1989 Feb;61(2):192-7. doi: 10.1136/hrt.61.2.192.
Patients with anomalous origin of the left coronary artery from the pulmonary trunk usually have a large right coronary artery. This study examines the diagnostic value of measuring the diameter of the right coronary artery by echocardiography in distinguishing between this lesion and other causes of dilated cardiomyopathy. The diameter of the right coronary artery and the right coronary artery/aorta ratio were measured in the parasternal short axis view in 40 controls, 11 patients with dilated cardiomyopathy, and 10 with anomalous origin of the left coronary artery from the pulmonary trunk. In the controls, the diameter of the right coronary artery increased with age, but the right coronary artery/aorta ratio remained constant. In the control group the 95% upper limits of prediction for right coronary artery diameter were 1.6 mm for one month of age, 1.8 mm for three months, 2.0 mm for one year, 2.2 mm for two years, 2.4 mm for three years, 2.6 mm for four years, 2.7 mm for six years, 3.0 mm for eight years, and 3.2 mm for 10 years; and for right coronary/aorta ratios the limits were 0.17 for one month to one year, 0.18 for one to six years, 0.19 for six to 10 years, and 0.20 for more than 10 years. All patients with dilated cardiomyopathy had normal right coronary artery diameters and right coronary artery/aorta ratios (0.10-0.13). Those patients with anomalous origin of the left coronary artery from the pulmonary trunk had larger than normal right coronary artery diameter and a significant increase in the right coronary artery/aorta ratio (0.21-0.29). The presence of an anomalous left coronary artery was likely if the diameter of the right coronary artery or the right coronary artery/aorta ratio was larger than the normal 95% limits of prediction.
左冠状动脉起源于肺动脉干的患者通常有粗大的右冠状动脉。本研究探讨了通过超声心动图测量右冠状动脉直径在鉴别该病变与其他扩张型心肌病病因方面的诊断价值。在40名对照组、11名扩张型心肌病患者以及10名左冠状动脉起源于肺动脉干的患者中，于胸骨旁短轴视图测量右冠状动脉直径及右冠状动脉/主动脉比值。在对照组中，右冠状动脉直径随年龄增加，但右冠状动脉/主动脉比值保持恒定。在对照组中，右冠状动脉直径的95%预测上限为：1月龄时为1.6mm，3月龄时为1.8mm，1岁时为2.0mm，2岁时为2.2mm，3岁时为2.4mm，4岁时为2.6mm，6岁时为2.7mm，8岁时为3.0mm，10岁时为3.2mm；右冠状动脉/主动脉比值的上限为：1月龄至1岁时为0.17，1至6岁时为0.18，6至10岁时为0.19，超过10岁时为0.20。所有扩张型心肌病患者的右冠状动脉直径及右冠状动脉/主动脉比值均正常（0.10 - 0.13）。那些左冠状动脉起源于肺动脉干的患者右冠状动脉直径大于正常，且右冠状动脉/主动脉比值显著增加（0.21 - 0.29）。如果右冠状动脉直径或右冠状动脉/主动脉比值大于正常95%预测上限，则可能存在左冠状动脉异常起源。
