Dupuis C, Ducoulombier H, Rey G, Choussat A, Jimenez M
Arch Mal Coeur Vaiss. 1987 Apr;80(4):500-11.
Twenty-four cases of anomalous origin of the left coronary artery from the pulmonary artery are reported. These cases were collected over 27 years divided into three 9-year periods according to the years of the initial studies. The clinical aspects and diagnostic investigations (notably echocardiography, myocardial radioisotope imaging and various angiographic procedures) are reviewed; aortography seems to be, even now, the best exploratory method. Treatment is analyzed according to the periods of observations. From the earliest cases it may be concluded that ligation proved ineffective in infants and medical treatment often failed. Progressively, medical treatment with digitalis (now better controlled), potassium-sparing diuretics and vasodilators has become more effective. On the other hand, direct reimplantation of the left coronary artery onto the aorta has become the preferred surgical procedure. Among the 8 most recent cases (seen between 1977 and 1986), 4 were cured by medical treatment under the age of 3 and subsequent reimplantation. In the other 4 patients asystolia responded to medical treatment, and these children are now awaiting reimplantation.
本文报告了24例左冠状动脉起源于肺动脉的病例。这些病例是在27年的时间里收集的，根据最初研究的年份分为三个9年时间段。对临床情况和诊断检查（尤其是超声心动图、心肌放射性核素成像和各种血管造影程序）进行了回顾；即使在现在，主动脉造影似乎仍是最佳的探查方法。根据观察时间段对治疗方法进行了分析。从最早的病例可以得出结论，结扎术对婴儿无效，药物治疗也常常失败。逐渐地，使用洋地黄（现在控制得更好）、保钾利尿剂和血管扩张剂的药物治疗变得更加有效。另一方面，将左冠状动脉直接重新植入主动脉已成为首选的外科手术方法。在最近的8例病例（1977年至1986年间观察到）中，4例在3岁以下通过药物治疗治愈，随后进行了重新植入手术。在另外4例患者中，心搏停止对药物治疗有反应，这些儿童目前正在等待重新植入手术。
