Menahem S, Venables A W
Department of Cardiology, Royal Children's Hospital, Melbourne, Australia.
Br Heart J. 1987 Oct;58(4):378-84. doi: 10.1136/hrt.58.4.378.
Eleven patients with anomalous left coronary artery arising from the pulmonary artery were identified from the beginning of 1970 to the end of 1985. The only male patient presented at the age of eight years for assessment of a murmur and was symptom free. The remainder presented in infancy with features of cardiac failure. The electrocardiogram was abnormal in all patients, the majority showing anterolateral ischaemia. Cross sectional echocardiography when available showed a dilated, poorly contracting left ventricle, and in two cases what appeared to be a "normal" origin of the left coronary artery. Aortography was performed in 10 patients and led to the correct diagnosis in eight. The diagnosis was made at necropsy in three infants. One patient has remained well without treatment. The anomalous left coronary artery was ligated in three of the earlier patients, including the asymptomatic boy. Two of these cases had concurrent saphenous vein graft to the anomalous left coronary artery. The four most recent cases were treated by successful direct reimplantation of the anomalous left coronary artery to the aorta when they first presented in infancy. They continue to improve symptomatically and show objective improvement of myocardial function. In this recent experience supports our policy of early surgical re-establishment of a two coronary system from the aorta.
1970年初至1985年末共确诊11例左冠状动脉起源于肺动脉的患者。唯一的男性患者8岁时因杂音前来评估，无症状。其余患者在婴儿期出现心力衰竭症状。所有患者的心电图均异常，大多数表现为前外侧心肌缺血。可用的横断面超声心动图显示左心室扩张、收缩功能差，2例患者左冠状动脉起源似乎“正常”。10例患者接受了主动脉造影，8例确诊。3例婴儿在尸检时确诊。1例患者未经治疗情况良好。包括无症状男孩在内的3例早期患者结扎了异常的左冠状动脉。其中2例同时进行了大隐静脉移植至异常左冠状动脉。最近的4例患者在婴儿期首次就诊时成功地将异常左冠状动脉直接重新植入主动脉。他们的症状持续改善，心肌功能客观上也有所改善。最近的经验支持我们早期通过手术从主动脉重建双冠状动脉系统的策略。
