Liu Xiao-Ping, Wang Hai-Jun, Gao Jin-Liang, Ma Guo-Li, Xu Xin-Yun, Ji Li-Na, He Rui-Xia, Qi Ba-Ya-Er, Wang Li-Cheng, Li Chang-Qing, Zhang Ya-Jiang, Feng Yu-Bao
Department of Cardiology, Ordos Clinical College of Inner Mongolia Medical University, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China.
Laboratory of Molecular Medicine, Ordos Clinical College of Inner Mongolia Medical University, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China.
World J Clin Cases. 2022 Jul 16;10(20):7045-7053. doi: 10.12998/wjcc.v10.i20.7045.
Atherosclerosis is one of the main causes of coronary artery ostial lesions seen clinically. Secondary coronary artery ostial lesions are rare, and cases reported previously were associated with syphilitic vasculitis and aortic dissection. Here, we report three rare cases of secondary coronary ostial lesions. Due to their rareness, these lesions can easily be neglected, which may lead to misdiagnosis and missed diagnosis.
We present three patients with acute myocardial infarction and unstable angina caused by secondary coronary artery ostial lesions. In Case 1, coronary angiography (CAG) revealed 90% stenosis of the left main coronary ostium. Chest contrast computed tomography (CT) suggested thymic carcinoma invading the left main coronary ostium. Coronary artery bypass grafting and tumor resection were performed. In Case 2, echocardiography revealed a sinus of Valsalva aneurysm (SVA)-like dilatation. CAG showed a right coronary sinus giant aneurysm and complete obstruction of the right coronary artery (RCA) ostium. Aortic contrast CT confirmed these findings. The Bentall procedure was performed. In Case 3, CT CAG identified an anomalous origin of the right coronary artery (AORCA) from the left sinus of Valsalva coursing between the aorta and pulmonary trunk, causing severe RCA ostium stenosis by compression. Surgical correction of the AORCA was performed.
The cases reported here suggest that we should consider other causes of coronary ostial lesions other than atherosclerosis.
动脉粥样硬化是临床上所见冠状动脉开口病变的主要原因之一。继发性冠状动脉开口病变较为罕见，既往报道的病例与梅毒性血管炎和主动脉夹层有关。在此，我们报告三例罕见的继发性冠状动脉开口病变病例。由于其罕见性，这些病变很容易被忽视，可能导致误诊和漏诊。
我们介绍了三例由继发性冠状动脉开口病变引起急性心肌梗死和不稳定型心绞痛的患者。病例1中，冠状动脉造影（CAG）显示左冠状动脉主干开口处狭窄90%。胸部对比计算机断层扫描（CT）提示胸腺癌侵犯左冠状动脉主干开口。进行了冠状动脉旁路移植术和肿瘤切除术。病例2中，超声心动图显示类似瓦氏窦瘤（SVA）样扩张。CAG显示右冠状动脉窦巨大动脉瘤和右冠状动脉（RCA）开口完全阻塞。主动脉对比CT证实了这些发现。进行了Bentall手术。病例3中，CT冠状动脉造影（CT CAG）发现右冠状动脉（AORCA）起源异常，起自左瓦氏窦，走行于主动脉和肺动脉干之间，因受压导致严重的RCA开口狭窄。对AORCA进行了手术矫正。
本文报道的病例提示，除动脉粥样硬化外，我们还应考虑冠状动脉开口病变的其他原因。
