Khan Muhammad S, Idris Owais, Shah Jay, Sharma Ravina, Singh Hemindermeet
Internal Medicine, Mercy St Vincent Medical Center, Toledo, USA.
Cardiology, Mercy St Vincent Medical Centre, Toledo, USA.
Cureus. 2020 Apr 22;12(4):e7777. doi: 10.7759/cureus.7777.
Congenital anomalies involving the origin of coronary arteries are rare and the most common anomaly is left circumflex (LCX) arising from the right sinus of Valsalva (RSV). Other anomalies include a single coronary artery from the left sinus of Valsalva, both coronary arteries from RSV and left anterior descending coronary artery (LAD) from RSV. Anomalous origin of left main from RSV carries a high risk of sudden cardiac arrest. A retrospective analysis and literature review of three patients admitted to our medical center with the acute coronary syndrome, who underwent coronary angiography and were found to have left main coronary artery (LMCA) originating from the right coronary cusp (RCA). One patient had non-diseased coronaries with symptoms caused by the variant anatomy with possible compression of the LMCA, whereas the other two patients had 100% occluded RCA with variable stenosis in the left coronary system. Eventual surgical re-implantation with bypass grafting was required in all three patients. LMCA from the RSV is a rare, but often fatal anomaly. Due to a lack of data and inability to predict sudden cardiac death, the latest guidelines recommend surgical intervention (class 1 recommendation) for all patients with LMCA from RSV, regardless of ischemia or ischemic symptoms.
涉及冠状动脉起源的先天性异常较为罕见，最常见的异常是左旋支（LCX）起源于瓦尔萨尔瓦右窦（RSV）。其他异常包括起源于瓦尔萨尔瓦左窦的单一冠状动脉、均起源于RSV的冠状动脉以及起源于RSV的左前降支冠状动脉（LAD）。左主干起源于RSV具有较高的心源性猝死风险。对我院收治的3例急性冠状动脉综合征患者进行回顾性分析并复习文献，这些患者接受了冠状动脉造影，发现左主干冠状动脉（LMCA）起源于右冠状动脉瓣叶（RCA）。1例患者冠状动脉无病变，症状由变异解剖结构导致，可能存在LMCA受压，而另外2例患者RCA完全闭塞，左冠状动脉系统存在不同程度狭窄。所有3例患者最终均需要进行手术重新植入并搭桥。起源于RSV的LMCA是一种罕见但常致命的异常。由于缺乏数据且无法预测心源性猝死，最新指南建议对所有起源于RSV的LMCA患者进行手术干预（I类推荐），无论是否存在缺血或缺血症状。
