Ajam Ali, Rahnamoun Zahra, Sahebjam Mohammad, Sattartabar Babak, Razminia Yasaman, Ahmadi Tafti Seyed Hossein, Hosseini Kaveh
Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Department of Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Echo Res Pract. 2022 Dec 6;9(1):12. doi: 10.1186/s44156-022-00012-7.
Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare coronary artery malformation with an incidence of 0.002% in patients undergoing coronary angiography. It can lead to an increased risk of myocardial infarction (MI) and sudden cardiac death, even in asymptomatic patients.
We conducted a review of published cases of ARCAPA using PubMed and Scopus databases and included patients over 18 years old with adequate echocardiographic data.
We evaluated 28 patients with ARCAPA with a mean age of 42.8 from 1979 to 2021. Patients were diagnosed mostly by angiography and echocardiography, the most performed treatment was reimplantation (15, 53.6%) and the main echocardiographic findings were dilated coronary arteries (9, 32.1%), coronary collaterals (8, 28.6%), and retrograde flow from right coronary arteries to main pulmonary trunk (7, 25%).
Although ARCAPA is rare and not as deadly as the anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) still there is a chance of serious outcomes, therefore surgical treatment should be performed upon diagnosis. Angiography is the gold standard for diagnosis, but echocardiography can be a convenient, non-invasive, and most reliable method as the primary step whenever ARCAPA is suspected.
右冠状动脉起源于肺动脉（ARCAPA）是一种罕见的冠状动脉畸形，在接受冠状动脉造影的患者中发生率为0.002%。即使在无症状患者中，它也会导致心肌梗死（MI）和心源性猝死风险增加。
我们使用PubMed和Scopus数据库对已发表的ARCAPA病例进行了综述，纳入了年龄超过18岁且有足够超声心动图数据的患者。
我们评估了1979年至2021年间28例ARCAPA患者，平均年龄42.8岁。患者大多通过血管造影和超声心动图诊断，最常进行的治疗是再植入术（15例，53.6%），主要超声心动图表现为冠状动脉扩张（9例，32.1%）、冠状动脉侧支循环（8例，28.6%）以及右冠状动脉向主肺动脉干的逆向血流（7例，25%）。
尽管ARCAPA罕见，且不像左冠状动脉起源于肺动脉（ALCAPA）那样致命，但仍有发生严重后果的可能，因此一经诊断应进行手术治疗。血管造影是诊断的金标准，但每当怀疑有ARCAPA时，超声心动图可作为首要步骤，是一种方便、无创且最可靠的方法。
