Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510100, China.
Shantou University Medical College, Shantou, Guangdong, China.
Int J Cardiovasc Imaging. 2020 Aug;36(8):1477-1487. doi: 10.1007/s10554-020-01857-x. Epub 2020 Apr 23.
To review the imaging characteristics of adult-type anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) and evaluate the post-operative echocardiographic features. The transthoracic echocardiography (TTE) records and invasive coronary angiography (ICA), coronary computed tomography angiography (CTA) or operative findings of thirty adult patients with final diagnosis of ALCAPA were reviewed at our center. The diagnostic reliability of TTE was determined by comparing its results with that of ICA/CTA, and the echocardiographic features of the patients during early visit and post-operative follow-up were summarized. The coincidence rate of TTE and ICA/CTA diagnosing ALCAPA was 96.3% (26/27), and one case was misdiagnosed as coronary artery fistula. All patients showed abnormal left coronary ostium arising from the pulmonary trunk with retrograde coronary artery flow, 20 patients had enlarged right coronary artery (RCA), and 20 showed abundant inter-coronary septal coronary collaterals. Left ventricle (LV) abnormalities such as wall thinning, abnormal wall motion, papillary muscle fibrosis, mitral valve (MV) prolapse and moderate-severe mitral regurgitation (MR) were respectively observed in 4, 7, 10, 8 and 10 patients. Three patients showed ventricular septal defect, patent foramen ovale and tetralogy of Fallot respectively. Post-operative data was available for 12 patients, and showed that the diameter of RCA, size of left atrium (LA) and LV were decreased after surgery compared to the respective pre-operative values. Furthermore, inter-coronary septal coronary collaterals lessened in 8 of these patients. Although 6 patients showed residual mild MR, moderate or severe MR was not observed, and the ejection fraction (EF) also showed no obvious changes before and after surgery. TTE is a non-invasive diagnostic tool for adult-type ALCAPA, and can indicate abnormal coronary origin, collateral arteries and other associated malformations. Some of the structural and hemodynamic parameters of adult-type ALCAPA were improved after surgery.
回顾成人型异常起源左冠状动脉来自肺动脉（ALCAPA）的影像学特征，并评估术后超声心动图特征。在我院，对 30 例最终诊断为 ALCAPA 的成人患者的经胸超声心动图（TTE）记录、介入性冠状动脉造影（ICA）、冠状动脉计算机断层血管造影（CTA）或手术结果进行了回顾性分析。通过比较 TTE 与 ICA/CTA 的结果，确定 TTE 的诊断可靠性，并总结了患者早期就诊和术后随访时的超声心动图特征。TTE 和 ICA/CTA 诊断 ALCAPA 的符合率为 96.3%（26/27），1 例误诊为冠状动脉瘘。所有患者均表现为异常的左冠状动脉起自肺动脉干，伴有逆行冠状动脉血流，20 例右冠状动脉（RCA）增大，20 例有丰富的冠状动脉间隔侧支循环。分别有 4、7、10、8 和 10 例患者出现左心室（LV）壁变薄、壁运动异常、乳头肌纤维化、二尖瓣（MV）脱垂和中重度二尖瓣反流（MR）等异常。3 例患者分别出现室间隔缺损、卵圆孔未闭和法洛四联症。术后资料可用于 12 例患者，与术前相比，术后 RCA 直径、左心房（LA）和 LV 大小均减小。此外，其中 8 例患者的冠状动脉间隔侧支循环减少。尽管 6 例患者仍有轻度 MR，但未观察到中度或重度 MR，且术后射血分数（EF）也无明显变化。TTE 是成人型 ALCAPA 的一种非侵入性诊断工具，可提示异常冠状动脉起源、侧支血管和其他相关畸形。成人型 ALCAPA 的一些结构和血流动力学参数在手术后得到改善。
