Bonelli Juan M, Schroh Ana M, Peirone Alejandro, Romero Gabriel, Schroh María L
Servicio de Tomografía Axial Computarizada, Fundación Escuela de Medicina Nuclear (FUESMEN), Mendoza, Argentina.
Sección de Ecocardiografía Pediátrica, Instituto de Cardiología Infantil, Mendoza, Argentina.
Arch Cardiol Mex. 2023 Sep 5;93(4):482-489. doi: 10.24875/ACM.22000136.
The anomalous aortic origin of the coronary arteries has an estimated prevalence of 0.02-5.7%. It can be associated with sudden death when it has an interarterial or intramural pathway or be damaged during interventions on the mitral, pulmonary and/or aortic annulus or percutaneous closure of an interatrial septal defect.
To identify these patients by imaging techniques such as transthoracic color Doppler echocardiography (TTE), computed tomography (CT) multislice angiography or coronary angiography.
The imaging techniques used for the detection of coronary anomalies were TTE, multislice coronary angiography or coronary angiography according to what is generally accepted.
Fifteen patients were identified; in 12 of them the suspicion was due to TTE and in the remaining 3, CT multislice angiography was diagnostic. The circumflex artery was the coronary artery most involved, associated or not with another coronary anomaly (12/15 patients) and in the other three cases, the anomalous coronary artery had an interarterial course, with the right coronary arteries and the anterior descending coronary arteries being involved.
The under diagnosis by TTE of coronary artery abnormalities may be due to the difficulty of visualization that is accentuated with age. Their detection is crucial because they can both, lead to sudden death associated with an intramural and/or interarterial pathway and complicate an interventional procedure on the interatrial septum or within the mitral, pulmonary and/or aortic rings.
冠状动脉异常起源的估计患病率为0.02 - 5.7%。当冠状动脉走行于动脉间或壁内时，可能与猝死相关，或者在二尖瓣、肺动脉和/或主动脉瓣环干预或经皮房间隔缺损封堵过程中受到损伤。
通过经胸彩色多普勒超声心动图（TTE）、计算机断层扫描（CT）多层血管造影或冠状动脉造影等成像技术识别这些患者。
根据普遍认可的方法，用于检测冠状动脉异常的成像技术为TTE、多层冠状动脉造影或冠状动脉造影。
共识别出15例患者；其中12例通过TTE检查产生怀疑，其余3例通过CT多层血管造影确诊。回旋支是受累最多的冠状动脉，可伴有或不伴有其他冠状动脉异常（12/15例患者），在其他3例中，异常冠状动脉走行于动脉间，累及右冠状动脉和前降支冠状动脉。
TTE对冠状动脉异常的诊断不足可能是由于随着年龄增长可视化难度增加所致。对其进行检测至关重要，因为它们既可能导致与壁内和/或动脉间走行相关的猝死，也可能使房间隔或二尖瓣、肺动脉和/或主动脉环内的介入手术复杂化。
