Ueeda M, Yamada N, Shimizu A, Hina K, Terasaka R, Saito D, Tsuji T, Yoshida H, Haraoka S
First Department of Internal Medicine, Okayama University Medical School.
J Cardiol. 1988 Jun;18(2):583-7.
An asymptomatic 48-year-old woman was admitted to our hospital for evaluation of a precordial continuous murmur. The chest radiograph showed a normal cardiac silhouette. The resting electrocardiogram showed incomplete right bundle branch block. A multistage, graded treadmill exercise test did not affect the ST-T segment. A thallium-201 myocardial perfusion scan with a multistage ergometer exercise test showed no distinct perfusion defect. A two-dimensional echocardiogram disclosed a dilated left coronary artery arising from the left sinus of Valsalva, and a dilated right coronary artery crossing the aorta anteriorly to the pulmonary trunk. Real-time two-dimensional Doppler echocardiography of the same region showed an abnormal jet coming from the right coronary artery into the pulmonary trunk during diastole. A continuous wave Doppler flow study in the pulmonary trunk revealed a high-speed, disturbed flow which began in mid-systole, and continued during diastole. These findings were compatible with anomalous origin of the right coronary artery from the pulmonary trunk. An aortogram confirmed the diagnosis.
一名48岁无症状女性因心前区连续性杂音入院接受评估。胸部X线片显示心脏轮廓正常。静息心电图显示不完全性右束支传导阻滞。多级分级平板运动试验未影响ST-T段。铊-201心肌灌注扫描及多级测力计运动试验显示无明显灌注缺损。二维超声心动图显示左冠状动脉起源于主动脉瓣左窦且扩张，右冠状动脉在主动脉前方横跨至肺动脉干前方且扩张。同一区域的实时二维多普勒超声心动图显示舒张期有异常血流从右冠状动脉进入肺动脉干。肺动脉干连续波多普勒血流研究显示高速紊乱血流，始于收缩中期并持续至舒张期。这些发现符合右冠状动脉起源于肺动脉干的异常情况。主动脉造影证实了诊断。
