Xie Zhongshang, Zou Junlin, Zhu Hong, Bu Haisong
Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
Front Cardiovasc Med. 2022 Jul 7;9:900803. doi: 10.3389/fcvm.2022.900803. eCollection 2022.
The aortic anomaly of the right coronary artery (AAORCA) originating from the left aortic sinus (LCS) is a rare malformation that may result in sudden cardiac death (SCD), which may be due to the dilated aorta-pulmonary artery affecting the blood supply of the coronary artery. However, there are still some disputes about the treatment of the AAORCA. Herein, we present a rare case of AAORCA from the LCS with aortic dissection (AD). Considering the risk of dissection rupture and SCD, an emergency surgery of aortic replacement and coronary anomaly correction was performed successfully for the patient. This report illustrated that AAORCA complicated with acute AD (AAD) is lethal and may promote the occurrence of coronary ischemia or sudden death by a new "double-kill" mechanism that myocardial ischemia was based on the extent of a fixed and a dynamic component like slit-like ostium, proximal narrowing, acute take-off angle and intramural course with the elliptic vessel shape. There is no doubt that surgery is the best treatment option for the AAORCA with AAD.
起源于左主动脉窦（LCS）的右冠状动脉主动脉异常（AAORCA）是一种罕见的畸形，可能导致心源性猝死（SCD），这可能是由于主动脉 - 肺动脉扩张影响冠状动脉的血液供应所致。然而，关于AAORCA的治疗仍存在一些争议。在此，我们报告一例罕见的起源于LCS并伴有主动脉夹层（AD）的AAORCA病例。考虑到夹层破裂和SCD的风险，为该患者成功实施了主动脉置换和冠状动脉异常矫正的急诊手术。本报告表明，AAORCA合并急性AD（AAD）具有致死性，可能通过一种新的“双重打击”机制促进冠状动脉缺血或猝死的发生，即心肌缺血基于诸如裂隙样开口、近端狭窄、急性起始角度和壁内走行以及椭圆形血管形状等固定和动态成分的程度。毫无疑问，手术是治疗伴有AAD的AAORCA的最佳选择。
