Department of Cardiovascular Surgery, Istanbul Medipol University Faculty of Medicine.
Department of Pediatric Cardiology, Istanbul Medipol University Faculty of Medicine.
Heart Surg Forum. 2021 Jan 20;24(1):E065-E071. doi: 10.1532/hsf.3421.
The coronary arteries, which have to originate from the aorta, may sometimes rise from the pulmonary artery. This study evaluated clinical and diagnostic findings, treatment methods, and follow up of cases with anomalous coronary arteries arising from the pulmonary artery.
Eight patients with the diagnosis of anomalous left coronary artery from the pulmonary artery (ALCAPA) (N = 6) and anomalous right coronary artery from the pulmonary artery (ARCAPA) (N = 2), between January 2014 and January 2020 from a single center university hospital, were included in the study. Data from patients' demographic characteristics, electrocardiography, echocardiography, angiographic findings, operation, hospitalization, and follow up were evaluated.
The study included eight patients (six females and two males) - six patients with ALCAPA and two with ARCAPA. The ages of the patients ranged between 3-135 (average: 53.25) months. The median body weight was calculated as 17.4 kg. Severe mitral valve insufficiency was detected in two patients and two other patients had a moderate degree of mitral insufficiency on echocardiography. Ejection fractions ranged between 16-74%. One patient had perimembranous malalignment large ventricular septal defect with pulmonary stenosis. Operative techniques were Takeuchi procedure (three patients), direct implantation (four patients), and left internal thoracic artery to left main coronary artery bypass (one patient). Mechanical cardiac support was not required in the postoperative period. Mortality did not occur. Mitral insufficiency and ejection fractions improved following correction of the coronary anatomy.
It is important to diagnose the ALCAPA or ARCAPA, where the coronary artery originates from the pulmonary artery. Patients should be treated before congestive heart failure and fatal complications occur. Surgical correction should be planned regardless of symptom status, even though some of patients reach adulthood with an increased number of collaterals.
冠状动脉必须起源于主动脉，但有时也会从肺动脉起始。本研究评估了起源于肺动脉的异常冠状动脉的临床和诊断发现、治疗方法和随访。
2014 年 1 月至 2020 年 1 月，我们从一家单中心大学医院纳入了 8 例诊断为左冠状动脉异常起源于肺动脉（ALCAPA，n=6）和右冠状动脉异常起源于肺动脉（ARCAPA，n=2）的患者。我们评估了患者的人口统计学特征、心电图、超声心动图、血管造影结果、手术、住院和随访的数据。
该研究纳入了 8 例患者（6 名女性和 2 名男性），6 例为 ALCAPA，2 例为 ARCAPA。患者年龄为 3-135 个月（平均 53.25 个月）。中位数体重为 17.4kg。2 例患者存在严重二尖瓣关闭不全，2 例患者的二尖瓣中度关闭不全。射血分数为 16-74%。1 例患者有单纯膜周部大室间隔缺损合并肺动脉瓣狭窄。手术技术为 Takeuchi 术式（3 例）、直接植入术式（4 例）和左内乳动脉到左主干冠状动脉旁路移植术（1 例）。术后不需要机械心脏支持。无死亡。冠状动脉解剖结构矫正后，二尖瓣关闭不全和射血分数得到改善。
诊断起源于肺动脉的 ALCAPA 或 ARCAPA 非常重要。应在充血性心力衰竭和致命并发症发生前对患者进行治疗。应计划进行手术矫正，而不论症状状态如何，尽管有些患者由于侧支循环的增加而在成年后出现。
