Sanders S P, Parness I A, Colan S D
Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115.
J Am Coll Cardiol. 1989 Mar 15;13(4):922-6. doi: 10.1016/0735-1097(89)90237-4.
Anomalous connection of a coronary artery to a ventricle or pulmonary artery causes shunting of blood from the coronary circuit and may produce myocardial ischemia. Such a coronary anomaly may occur in isolation or with other defects. Doppler color flow mapping and two-dimensional echocardiography were used to diagnose anomalous coronary connections in 13 patients, 1 day to 7 years of age, over a 1 year period. The diagnoses were anomalous origin of the left coronary artery from the pulmonary trunk in five patients, a coronary artery to left ventricle fistula or coronary artery to pulmonary artery fistula in four patients with other complex defects, right ventricular sinusoids in two patients with pulmonary atresia and intact ventricular septum and an isolated coronary artery fistula in two patients. In all cases, the abnormal coronary connection was recognized on the basis of an abnormal, continuous or to and fro flow pattern in the fistula and its connections as demonstrated by scanning in multiple views with Doppler color flow mapping. The low spatial resolution of Doppler color flow mapping limits the anatomic detail available; nonetheless, it is a significant advance in the noninvasive diagnosis of abnormal coronary connections.
冠状动脉与心室或肺动脉的异常连接会导致血液从冠状动脉循环分流，并可能产生心肌缺血。这种冠状动脉异常可能单独出现，也可能与其他缺陷同时存在。在1年的时间里，使用多普勒彩色血流图和二维超声心动图对13例年龄在1天至7岁的患者进行了异常冠状动脉连接的诊断。诊断结果为：5例患者左冠状动脉起源于肺动脉干；4例合并其他复杂缺陷的患者存在冠状动脉至左心室瘘或冠状动脉至肺动脉瘘；2例肺动脉闭锁且室间隔完整的患者存在右心室窦状隙；2例患者存在孤立性冠状动脉瘘。在所有病例中，通过多普勒彩色血流图在多个视图中扫描显示，基于瘘管及其连接中异常的、连续的或往返的血流模式，识别出了异常冠状动脉连接。多普勒彩色血流图的低空间分辨率限制了可获得的解剖细节；尽管如此，它在异常冠状动脉连接的无创诊断方面仍是一项重大进展。
