Chaosuwannakit Narumol, Makarawate Pattarapong
Radiology Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Cardiology Unit, Internal Medicine Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Int J Cardiol Heart Vasc. 2021 Jan 31;32:100723. doi: 10.1016/j.ijcha.2021.100723. eCollection 2021 Feb.
Clinically recognized coronary anomalies in adults are infrequent and characteristically establish on autopsy. The clinical importance coronary arteries consist of those with anomalous origin of the coronary artery from the opposite sinus of Valsalva (ACAOS) with an inter-arterial course (IAC). We have endeavored to attribute variable risk based on morphological appearances of the ACAOS by dual-source coronary computed tomography angiography (DSCTA).
ACAOS patients who undergoing DSCTA over a 5-year period were identified and assess morphologic characteristics. Medical records were reviewed for major adverse cardiovascular events (MACEs).
A total of 1126 patients who undergoing DSCTA were evaluated. Twenty-four patients with ACAOS with IAC were recognized with a prevalence of 2.1% of study population. Twenty patients had anomalous origin of right coronary artery from left sinus of Valsalva (RCA-LSV) and 4 patients had anomalous origin of left coronary from right sinus of Valsalva (LCA-RSV). A significant increased prevalence of MACEs in were observed in intramural, slit-like and high inter-arterial course morphology group. Median follow-up time was 13 months (IQR 3-18 months). During follow-up 2 died, 4 had PCI, 13 had myocardial infarction and 7 had surgical treatment.
Intramural, slit-like and high type inter-arterial course morphology of ACAOS with IAC are high risk features for MACEs which can be identified by DSCTA.
成人临床可识别的冠状动脉异常并不常见，通常在尸检时发现。具有临床重要性的冠状动脉异常包括冠状动脉起源于对侧瓦尔萨尔瓦窦（ACAOS）并走行于动脉间（IAC）的情况。我们试图通过双源冠状动脉计算机断层扫描血管造影（DSCTA）根据ACAOS的形态外观来确定不同的风险。
确定5年内接受DSCTA检查的ACAOS患者，并评估其形态特征。回顾医疗记录以了解主要不良心血管事件（MACE）。
共评估了1126例接受DSCTA检查的患者。24例具有IAC的ACAOS患者被识别出来，占研究人群的2.1%。20例患者右冠状动脉起源于左瓦尔萨尔瓦窦（RCA-LSV），4例患者左冠状动脉起源于右瓦尔萨尔瓦窦（LCA-RSV）。在壁内、裂隙状和高动脉间走行形态组中观察到MACE的患病率显著增加。中位随访时间为13个月（四分位间距3 - 18个月）。随访期间，2例死亡，4例接受了经皮冠状动脉介入治疗（PCI），13例发生心肌梗死，7例接受了手术治疗。
具有IAC的ACAOS的壁内、裂隙状和高类型动脉间走行形态是MACE的高风险特征，可通过DSCTA识别。
