Zuo Hairun, Xu Chengyi, Wang Li, Liu Chengwei, Liu Li, Su Xi
Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China.
Front Cardiovasc Med. 2023 May 22;10:1167698. doi: 10.3389/fcvm.2023.1167698. eCollection 2023.
Anomalous aortic origin of a coronary artery (AAOCA) is a congenital malformation of the coronary arteries that includes several subtypes. It is a leading cause of sudden cardiac death in young people, especially in competitive athletes. An accurate diagnosis and identification of high-risk patients with AAOCA for referral for surgical repair can help in the management of these patients. However, current diagnostic tools such as invasive angiography, echocardiography, and intravascular ultrasound have known limitations in visualizing coronary orifices and characterizing vessels. In this case report, we report on a 14-year-old adolescent who suffered from repeated incidents of syncope during exercise. Using the computed tomographic fractional flow reserve (CT-FFR) technique, we diagnosed AAOCA, which revealed that his left coronary artery (LCA) originated from the right sinus of Valsalva and ran between the aorta and the pulmonary artery with an intra-arterial wall course (∼20 mm in length), with an abnormal FFR of the LCA at rest. The patient was referred for undergoing unroofing surgery, and the results of repeat CT-FFR showed a significantly improved FFR of the LCA. The patient resumed his normal physical activities without the recurrence of syncope. In this report, we highlight the usefulness of CT-FFR as a non-invasive, feasible, and effective tool to guide whether a patient with AAOCA requires surgical revascularization and to evaluate the effectiveness of the procedure after surgery.
冠状动脉异常起源（AAOCA）是一种冠状动脉先天性畸形，包括几种亚型。它是年轻人尤其是竞技运动员心脏性猝死的主要原因。准确诊断并识别AAOCA高危患者以转介进行手术修复有助于这些患者的管理。然而，目前的诊断工具，如侵入性血管造影、超声心动图和血管内超声，在显示冠状动脉口和表征血管方面存在已知局限性。在本病例报告中，我们报道了一名14岁青少年，他在运动期间反复出现晕厥事件。使用计算机断层扫描血流储备分数（CT-FFR）技术，我们诊断出AAOCA，结果显示他的左冠状动脉（LCA）起源于主动脉窦右窦，走行于主动脉和肺动脉之间，呈动脉壁内走行（长度约20 mm），静息时LCA的血流储备分数异常。该患者被转介接受开窗手术，重复CT-FFR结果显示LCA的血流储备分数显著改善。患者恢复了正常体力活动，未再发生晕厥。在本报告中，我们强调了CT-FFR作为一种非侵入性、可行且有效的工具，用于指导AAOCA患者是否需要进行手术血运重建以及评估手术后该手术的效果。
