Matsunaga N, Hayashi K, Sakamoto I, Ogawa Y, Matsuoka Y, Imamura T, Kuriya T
Department of Radiology, Nagasaki University School of Medicine, Japan.
Radiology. 1993 Mar;186(3):877-82. doi: 10.1148/radiology.186.3.8094253.
Coronary-to-pulmonary artery shunts via the bronchial artery (CA-BA-PA shunts) were observed in 16 of 2,922 consecutive patients who underwent selective coronary cineangiography. Underlying diseases included Takayasu arteritis (n = 8), chronic pulmonary inflammatory diseases (n = 4), pulmonary thromboembolism (n = 2), pulmonary artery tumor (n = 1), and tetralogy of Fallot with pulmonary atresia (n = 1). Ventilation-perfusion scans were available in 15 of the 16 patients. Mismatched defects were identified in 11 patients, and matched defects were identified in four. Bronchial-to-pulmonary artery shunts were detected on selective bronchial angiograms and/or thoracic aortograms in 13 patients. Feeding arteries of the CA-BA-PA shunts included left atrial branches (n = 13), right sinus node branches (n = 7), left sinus node branches (n = 2), right conal branch (n = 1), left conal branch (n = 1), and posterolateral branches (n = 2). These coronary branches seemed to serve as collateral vessels from a coronary arterial system with a higher pressure to a pulmonary arterial system with a lower pressure in conditions of decreased pulmonary flow or in cases of chronic pulmonary inflammatory disease. The importance of the coronary artery along with other superior thoracic collateral networks in contributing to the development of shunts to the pulmonary artery is underscored.
在2922例连续接受选择性冠状动脉造影的患者中，观察到16例存在经支气管动脉的冠状动脉至肺动脉分流（CA - BA - PA分流）。基础疾病包括大动脉炎（8例）、慢性肺部炎症性疾病（4例）、肺血栓栓塞（2例）、肺动脉肿瘤（1例）以及法洛四联症合并肺动脉闭锁（1例）。16例患者中有15例进行了通气灌注扫描。11例患者发现不匹配的缺损，4例发现匹配的缺损。13例患者在选择性支气管造影和/或胸主动脉造影中检测到支气管至肺动脉分流。CA - BA - PA分流的供血动脉包括左心房分支（13例）、右窦房结分支（7例）、左窦房结分支（2例）、右圆锥支（1例）、左圆锥支（1例）和后外侧分支（2例）。在肺血流减少或慢性肺部炎症性疾病的情况下，这些冠状动脉分支似乎起到了从压力较高的冠状动脉系统向压力较低的肺动脉系统的侧支血管作用。强调了冠状动脉以及其他胸上部侧支网络在促成肺动脉分流形成中的重要性。
