Gao Yumeng, Zhang Qingyou, Sun Yan, Du Junbao
Department of Pediatrics, Peking University First Hospital, Beijing, China.
Front Pediatr. 2022 Jul 5;10:879753. doi: 10.3389/fped.2022.879753. eCollection 2022.
This study is aimed to analyze the characteristics of congenital anomalous origin of coronary artery in pediatric patients with syncope.
A total of eight patients were retrospectively analyzed from August 2018 to August 2020 who were admitted to the Peking University First Hospital with the complaint of syncope and were diagnosed with congenital coronary artery disease.
In total, eight patients were included in the study with a median age of 12.5 ± 2.7 (8-16) years. In total, four of them were males, and four were females. Six of the eight patients were diagnosed with right anomalous coronary artery from the opposite sinus (R-ACAOS), while two patients were diagnosed with left anomalous coronary artery from the opposite sinus (L-ACAOS). The most frequent inducement was exercise, and the commonest prodromes were dizziness and blurred vision. Serum cardiac markers and exercise electrocardiography test (EET) were normal in seven of the patients. The majority of cases had abnormal electrocardiograms (ECGs), but only two of them manifested elevated/depressed ST-T segments. In total, seven patients had positive head-up tilt test (HUT). Echocardiography and coronary artery computed tomography angiography (CTA) were performed to aid the diagnosis. Coronary unroofing procedures were conducted in four patients, and none of them reported syncope after the surgery. The other four patients received routine medical treatment for vasovagal-like syncope. In total, two patients out of them became asymptomatic, and in the other two patients, episodes of syncope were reduced, but they still required medical treatment.
Congenital coronary artery anomalies in children with syncope need prompt attention. Though ECG and echocardiography are the common methods for investigating cardiac syncope, they have limited ability to find coronary artery anomalies. When coronary artery anomalies are suspected, coronary CTA should be considered.
本研究旨在分析小儿晕厥患者先天性冠状动脉异常起源的特征。
回顾性分析2018年8月至2020年8月期间北京大学第一医院收治的8例以晕厥为主要诉求且被诊断为先天性冠状动脉疾病的患者。
本研究共纳入8例患者，中位年龄为12.5±2.7（8 - 16）岁。其中男性4例，女性4例。8例患者中有6例被诊断为对侧窦右冠状动脉异常起源（R - ACAOS），2例被诊断为对侧窦左冠状动脉异常起源（L - ACAOS）。最常见的诱发因素是运动，最常见的前驱症状是头晕和视力模糊。7例患者的血清心肌标志物和运动心电图试验（EET）正常。大多数病例心电图（ECG）异常，但仅有2例表现为ST - T段抬高/压低。共有7例患者直立倾斜试验（HUT）阳性。行超声心动图和冠状动脉计算机断层扫描血管造影（CTA）以辅助诊断。4例患者进行了冠状动脉开窗手术，术后均未再发生晕厥。另外4例患者接受了类似血管迷走性晕厥的常规治疗。其中2例患者无症状，另外2例患者晕厥发作次数减少，但仍需治疗。
晕厥儿童的先天性冠状动脉异常需引起及时关注。虽然心电图和超声心动图是调查心源性晕厥的常用方法，但它们发现冠状动脉异常的能力有限。当怀疑有冠状动脉异常时，应考虑冠状动脉CTA检查。
