Sousa Helena, Casanova Jorge
Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
Serviço de Cirurgia Cardiotorácica, Centro Hospitalar S. João, Porto, Portugal.
Rev Port Cardiol (Engl Ed). 2018 Mar;37(3):227-235. doi: 10.1016/j.repc.2017.06.019. Epub 2018 Mar 21.
Patients with anomalous coronary arteries arising from the opposite sinus of Valsalva (ACAOS), the left coronary artery (LCA) arising from the right sinus or the right coronary artery (RCA) from the left sinus with an interarterial course, may present from complete absence of symptoms to sudden cardiac death. Although there are guidelines on indications for surgery, controversy remains.
A retrospective review was performed of all adult patients diagnosed with ACAOS in our hospital between 2007 and 2016. Demographic, clinical, perioperative and follow-up data were collected from clinical records and summarized. A review of the published literature was performed with special emphasis on clinical presentation, surgical indications and results.
Seven symptomatic patients underwent surgery (mean age 57.1±8.9 years, two male, five female); they recovered without complications and to date have had no recurrence of myocardial ischemia. One asymptomatic patient with an anomalous RCA has been medically followed without evidence of myocardial ischemia. A 75-year-old woman, diagnosed in 2008 with an anomalous LCA, was not referred for surgery and died suddenly six months after diagnosis.
Surgery for coronary abnormalities is performed with low risk and all published series report full operative survival. The indications for surgery are well established for patients with interarterial anomalous LCA and symptomatic patients with interarterial anomalous RCA. However, there is some uncertainty concerning asymptomatic patients, particularly those with an anomalous interarterial RCA, for whom we propose a more assertive approach, if young or engaged in strenuous activities.
起源于对侧主动脉窦（ACAOS）的异常冠状动脉患者，即左冠状动脉（LCA）起源于右窦或右冠状动脉（RCA）起源于左窦且走行于动脉之间，可能完全没有症状，也可能发生心源性猝死。尽管有关于手术指征的指南，但仍存在争议。
对2007年至2016年期间我院诊断为ACAOS的所有成年患者进行回顾性研究。从临床记录中收集人口统计学、临床、围手术期和随访数据并进行总结。对已发表的文献进行综述，特别关注临床表现、手术指征和结果。
7例有症状的患者接受了手术（平均年龄57.1±8.9岁，2例男性，5例女性）；他们术后恢复良好，无并发症，迄今为止心肌缺血未复发。1例无症状的异常RCA患者接受了药物随访，无心肌缺血证据。1例75岁女性于2008年被诊断为异常LCA，未接受手术治疗，诊断后6个月突然死亡。
冠状动脉异常手术风险较低，所有已发表的系列报道手术生存率均为100%。对于走行于动脉之间的异常LCA患者和有症状的走行于动脉之间的异常RCA患者，手术指征已明确。然而，无症状患者，尤其是异常走行于动脉之间的RCA患者，存在一些不确定性，对于这类患者，如果年轻或从事剧烈活动，我们建议采取更积极的治疗方法。
