Khan Zahid
Acute Medicine, Mid and South Essex National Health Service (NHS) Foundation Trust, Southend-on-Sea, GBR.
Cardiology, Barts Heart Centre, London, GBR.
Cureus. 2024 Mar 8;16(3):e55810. doi: 10.7759/cureus.55810. eCollection 2024 Mar.
A congenital anomalous origin of the coronary artery is a rare cardiovascular malformation that includes the left circumflex artery arising from the right sinus of Valsalva (RSV), both coronary arteries arising from RSV, the left anterior descending (LAD) artery arising from the respiratory sinus arrhythmia, and a single coronary artery arising from the left sinus of Valsalva. We present the case of a 72-year-old patient presenting with chest pain to his local hospital while cycling. Troponin levels peaked from 90 to 360 ng/L, and electrocardiography showed normal sinus rhythm and left bundle branch block. Echocardiography showed good left ventricular function with an ejection fraction of 55% and no regional wall motion abnormalities. The patient underwent coronary angiography, which revealed a severe proximal right coronary artery (RCA) lesion and an aberrant LAD artery. He underwent primary percutaneous coronary angioplasty of the RCA and was discharged home with dual antiplatelet therapy and high-dose statins. CT coronary angiography revealed an aberrant LAD and patent RCA stent with mild to moderate disease in the distal vessel, and he was reviewed in the outpatient clinic.
先天性冠状动脉异常起源是一种罕见的心血管畸形，包括左旋支动脉起源于瓦尔萨尔瓦窦（RSV）右侧、两支冠状动脉均起源于RSV、左前降支（LAD）动脉起源于呼吸性窦性心律失常以及单支冠状动脉起源于瓦尔萨尔瓦窦左侧。我们报告一例72岁患者，在骑自行车时因胸痛到当地医院就诊。肌钙蛋白水平从90 ng/L升至360 ng/L，心电图显示窦性心律正常及左束支传导阻滞。超声心动图显示左心室功能良好，射血分数为55%，无节段性室壁运动异常。患者接受了冠状动脉造影，结果显示右冠状动脉（RCA）近端严重病变及一支异常的LAD动脉。他接受了RCA的直接经皮冠状动脉腔内血管成形术，并接受双联抗血小板治疗和大剂量他汀类药物后出院回家。CT冠状动脉造影显示一支异常的LAD动脉及RCA支架通畅，远端血管有轻至中度病变，患者在门诊接受了复查。
