Department of Radiology, Wuhan Asia Heart Hospital, Wuhan, China.
Department of Cardiac Function, Wuhan Asia General Hospital, Wuhan, China.
J Card Surg. 2022 Sep;37(9):2842-2844. doi: 10.1111/jocs.16727. Epub 2022 Jul 3.
We report a hitherto unreported combination of pulmonary stenosis, single coronary artery anomaly and coronary sinus to left atrial communication. Our case highlights the important value of coronary computed tomographic angiography and transthoracic echocardiography for the diagnosis of such anomalies and guidance for proper management.
A 64-year-old male presented chest tightness and shortness of breath for 2 days. Transthoracic echocardiography revealed a thickened pulmonary valve leaflet and subvalvular outflow tract stenosis, colour flow Doppler showed a significant accelerated blood flow in the pulmonary artery cavity originating from the subvalvular outflow tract, continuous wave Doppler revealed the transpulmonary valvular pressure gradient of 63mmHg. Computed tomographic angiography image reveals thickened pulmonary valve leaflets and subvalvular outflow tract stenosis, single coronary artery anomaly and levoatriocardinal vein. The patient underwent percutaneous pulmonary valve balloon dilatation, the post-procedural course was uneventful.
Pulmonary stenosis can occur as part of more congenital cardiac malformations or as rare primary isolated pulmonary stenosis, which includes the valvular, sub-valvular, or supra-valvular pulmonary stenosis. Single coronary artery anomalies are very rare, anomalous right coronary artery originates from proximal to mid-left anterior descending coronary artery is one such single coronary artery anomaly, in most cases, it is asymptomatic, diagnosed incidentally, and a benign entity has a better prognosis except if the right coronary artery is passing between the aorta and pulmonary artery. This course of the right coronary artery anomaly is malignant. Coronary sinus to left atrial communication includes a direct or indirect communication. The direct communication is described as a partial or complete absence of the roof between the coronary sinus and left atrium, as it is well known as the unroofed coronary sinus syndrome. The indirect communication is an anomalous bridging vein communicating the coronary sinus to the left atrium, which can be distinguished from classical unroofed coronary sinus syndrome. The venous collateral channel communication between the coronary sinus to the left atrium by a bridging vein is also categorized as a variant type of unroofed coronary sinus syndrome. Understanding coronary venous variations has significant clinical implications particularly in the realm of electrophysiology. The anatomical variations can have important consequences for procedures such as biventricular pacing and trans-coronary vein ablations.
Pulmonary stenosis combined with single coronary artery anomaly and bridging vein communication between the coronary sinus and the left atrium is an extremely rare. Coronary computed tomographic angiography and transthoracic echocardiographyplay an important role the diagnosis of such anomalies and guidance for clinical Treatment.
我们报告了一种迄今尚未报道的肺狭窄、单冠状动脉异常和冠状窦至左心房交通的组合。我们的病例突出了冠状动脉计算机断层血管造影术和经胸超声心动图在诊断此类异常和指导适当治疗方面的重要价值。
一名 64 岁男性因胸闷和呼吸急促 2 天就诊。经胸超声心动图显示瓣叶增厚和瓣下流出道狭窄，彩色血流多普勒显示起源于瓣下流出道的肺动脉腔内明显加速血流，连续波多普勒显示跨瓣压差为 63mmHg。计算机断层血管造影图像显示瓣叶增厚和瓣下流出道狭窄、单冠状动脉异常和左旋心静脉。患者接受了经皮肺动脉瓣球囊扩张术，术后过程顺利。
肺狭窄可作为更多先天性心脏畸形的一部分，或作为罕见的原发性孤立性肺狭窄，包括瓣、瓣下或瓣上肺动脉狭窄。单冠状动脉异常非常罕见，异常右冠状动脉起源于左前降支近段，是一种单冠状动脉异常，在大多数情况下，它是无症状的，偶然诊断，是良性实体，预后较好，除非右冠状动脉位于主动脉和肺动脉之间。这种右冠状动脉异常的过程是恶性的。冠状窦至左心房交通包括直接或间接交通。直接沟通被描述为冠状窦和左心房之间的屋顶部分或完全缺失，因为它被称为无屋顶冠状窦综合征。间接沟通是异常的桥静脉沟通冠状窦和左心房，可以从经典的无屋顶冠状窦综合征中区分出来。冠状窦与左心房之间的静脉侧支通道通过桥静脉沟通也归类为无屋顶冠状窦综合征的变异型。了解冠状静脉的变异对电生理学领域具有重要的临床意义。解剖学变异对双心室起搏和经冠状静脉消融等程序有重要影响。
肺狭窄合并单冠状动脉异常和冠状窦与左心房之间的桥静脉交通极为罕见。冠状动脉计算机断层血管造影术和经胸超声心动图在诊断此类异常和指导临床治疗方面发挥着重要作用。
