McConnell M V, Ganz P, Selwyn A P, Li W, Edelman R R, Manning W J
Cardiovascular Division, Beth Israel Hospital, Boston, MA 02215, USA.
Circulation. 1995 Dec 1;92(11):3158-62. doi: 10.1161/01.cir.92.11.3158.
Anomalous coronary arteries are a rare but recognized cause of myocardial ischemia and sudden death. Identification currently requires x-ray angiography, which may have difficulty defining the three-dimensional course of the anomalous vessel. Magnetic resonance coronary angiography (MRCA) has been shown to image coronary artery anatomy noninvasively. We hypothesize that MRCA may be useful in the identification of anomalous coronary arteries and their anatomic course.
Sixteen patients (9 men, 7 women, age 44 to 81 years) with anomalous aortic origins of the coronary arteries by conventional x-ray angiography underwent MRCA. Multiple images of the major epicardial coronary arteries were obtained by use of a breathhold, fat-suppressed, segmented-k space, gradient-echo technique by investigators blinded to all patient data. Anomalous coronary artery pathology, by x-ray angiography, included right-sided left main coronary artery (n = 3), right-sided left circumflex artery (n = 6), separate left-sided left anterior descending and left circumflex arteries (n = 2), left-sided right coronary artery (n = 4), and an anteriorly displaced right coronary artery (n = 1). MRCA correctly identified the anomalous coronary vessel(s) in 14 of 15 patients. In 1 patient, the anomalous vessel was incorrectly identified, and in 2 patients the course of the anomalous vessel was not clearly seen; one of these was a nondominant, anomalous right coronary artery.
MRCA is a useful technique for the noninvasive identification of anomalous coronary arteries and their anatomic course.
冠状动脉异常是心肌缺血和猝死的一种罕见但已被认识的病因。目前的识别需要进行X线血管造影，而这可能难以明确异常血管的三维走行。磁共振冠状动脉造影（MRCA）已被证明可无创地显示冠状动脉解剖结构。我们推测MRCA可能有助于识别冠状动脉异常及其解剖走行。
16例经传统X线血管造影证实冠状动脉起源于主动脉异常的患者（9例男性，7例女性，年龄44至81岁）接受了MRCA检查。由对所有患者数据不知情的研究人员采用屏气、脂肪抑制、分段k空间梯度回波技术获取主要心外膜冠状动脉的多幅图像。经X线血管造影显示的冠状动脉异常病理情况包括右侧左主干冠状动脉（n = 3）、右侧左旋支动脉（n = 6）、左侧单独的左前降支和左旋支动脉（n = 2）、左侧右冠状动脉（n = 4）以及向前移位的右冠状动脉（n = 1）。MRCA在15例患者中的14例中正确识别出了异常冠状动脉。在1例患者中，异常血管被错误识别，在2例患者中异常血管的走行未清晰显示；其中1例为非优势的异常右冠状动脉。
MRCA是一种用于无创识别冠状动脉异常及其解剖走行的有用技术。
