Swensson R E, Murillo-Olivas A, Elias W, Bender R, Daily P O, Sahn D J
Division of Pediatric Cardiology, University of California at San Diego 92103.
J Am Coll Cardiol. 1988 Mar;11(3):659-61. doi: 10.1016/0735-1097(88)91546-x.
Anomalous origin of the left coronary artery from the pulmonary artery is a rare but important cause of congestive heart failure in infancy and of sudden death at all ages. Diagnosis is often missed when based solely on physical examination and noninvasive methods. A 4 year old patient is presented in whom mitral regurgitation was noted by a referring physician and an anomalous left coronary artery was found by Doppler color flow mapping upon referral and verified at cardiac catheterization. Doppler color flow mapping was also used intraoperatively using a gas-sterilized transducer to further clarify the hemodynamics and assess the surgical result. After creation of an intrapulmonary artery tunnel from the ostium of the left coronary artery to the aorta, anterograde coronary artery flow and absence of a residual left to right pulmonary artery shunt were verified during surgery by Doppler flow mapping. Postoperatively, residual mitral regurgitation and patency of the left coronary artery graft have been followed up serially by Doppler flow mapping. Therefore, Doppler color flow mapping is useful in the diagnosis and intraoperative and postoperative management of this important and potentially life-threatening abnormality.
左冠状动脉起源于肺动脉是婴儿期充血性心力衰竭以及各年龄段猝死的一种罕见但重要的病因。仅基于体格检查和非侵入性方法时，诊断常常会被漏诊。本文介绍了一名4岁患者，转诊医生发现其存在二尖瓣反流，转诊时通过多普勒彩色血流图发现左冠状动脉异常，并在心脏导管检查时得到证实。术中还使用气体消毒的换能器进行多普勒彩色血流图检查，以进一步明确血流动力学情况并评估手术结果。在建立从左冠状动脉开口到主动脉的肺动脉内隧道后，术中通过多普勒血流图证实了冠状动脉顺行血流以及左向右肺动脉分流残余的不存在。术后，通过多普勒血流图对残余二尖瓣反流和左冠状动脉移植物的通畅情况进行了连续随访。因此，多普勒彩色血流图对于这种重要且可能危及生命的异常情况的诊断、术中及术后管理很有用。
