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通过无创成像检查对症状性右冠状动脉起源于肺动脉的解剖学和生理学评估。

Anatomical and physiological assessment of a symptomatic anomalous origin of the right coronary artery from the pulmonary artery by noninvasive imaging examinations.

作者信息

Nishino Shun, Watanabe Nozomi, Komatsu Miyo, Yano Mitsuhiro, Shibata Yoshisato

机构信息

Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center, Miyazaki, Japan.

Department of Cardiothoracic Surgery, Miyazaki Medical Association Hospital Cardiovascular Center, Miyazaki, Japan.

出版信息

J Cardiol Cases. 2020 Jun 4;22(2):72-76. doi: 10.1016/j.jccase.2020.05.002. eCollection 2020 Aug.

Abstract

A 58-year-old female visited our hospital complaining of fatigue and repetitive pre-syncope during exercise. She had suffered with those symptoms for decades and had visited some hospitals where she did not get conclusive diagnosis. She was ultimately diagnosed as having subclinical ventricular septal defect unrelated to her symptoms. Echocardiography revealed normal ventricular function, but color Doppler showed multiple abnormal intramyocardial blood flow signals in ventricular septum and moderator band, which suggested abnormally developed coronary perfusion. Dilated left main trunk and abnormal color Doppler signal running into the main pulmonary trunk were also observed. Coronary computed tomography angiography revealed that right coronary artery originated from pulmonary artery and made connection to distal left anterior descending artery, which led to the final diagnosis of anomalous origin of the right coronary artery from the pulmonary artery. Exercise stress echocardiography showed wall motion abnormalities in inferior region which suggested ischemia in right coronary artery (RCA) territory. Her symptoms could be derived from the myocardial ischemia. She was referred to surgical intervention considering the possible risk of cardiac events including sudden death. Re-implantation of the abnormal RCA to the aorta was performed successfully. Her long-year persistent symptoms were completely alleviated, and repeat exercise stress echocardiography showed no evidence of ischemia. < We report an adult case of symptomatic anomalous origin of the right coronary artery from the pulmonary artery, who had not been given the correct diagnosis. Noninvasive diagnostic examinations including transthoracic Doppler echocardiography, exercise stress echocardiography and coronary computed tomography angiography contributed to the anatomical and physiological assessment of the rare congenital heart disease before and after the successful coronary re-implantation surgery.>.

摘要

一名58岁女性因运动时疲劳和反复出现晕厥前症状前来我院就诊。她出现这些症状已有数十年,曾就诊于多家医院,但均未得到明确诊断。最终她被诊断为亚临床室间隔缺损,与症状无关。超声心动图显示心室功能正常,但彩色多普勒显示室间隔和节制索内有多个异常心肌内血流信号,提示冠状动脉灌注发育异常。还观察到左主干扩张以及异常彩色多普勒信号延伸至主肺动脉。冠状动脉计算机断层扫描血管造影显示右冠状动脉起源于肺动脉,并与左前降支远端相连,最终诊断为右冠状动脉起源于肺动脉异常。运动负荷超声心动图显示下壁区域室壁运动异常,提示右冠状动脉(RCA)供血区域缺血。她的症状可能源于心肌缺血。考虑到包括猝死在内的心脏事件的潜在风险,她被转诊接受手术干预。成功将异常的右冠状动脉重新植入主动脉。她长期持续的症状完全缓解,重复运动负荷超声心动图显示无缺血证据。<我们报告一例有症状的右冠状动脉起源于肺动脉的成人病例,此前未得到正确诊断。包括经胸多普勒超声心动图、运动负荷超声心动图和冠状动脉计算机断层扫描血管造影在内的非侵入性诊断检查有助于在成功进行冠状动脉重新植入手术前后对这种罕见先天性心脏病进行解剖和生理评估。>

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