Musiani A, Maselli D, Casolo F, Calì G, De Gasperis C
Divisione di Cardiochirurgia, Ospedale Maggiore di Novara.
G Ital Cardiol. 1993 Apr;23(4):365-9.
The authors report a rare case of atresia of the left main coronary artery in an adult patient, symptomatic for effort angina. At coronarography, the left main coronary artery was not found; instead, the arteries of the left coronary tree were filled via a single collateral vessel arising from the ostium of the right coronary artery and ending in the trunk of the left anterior descending artery. All left arteries had very narrow calibres, almost hypoplastic, while the right coronary artery had a normal calibre. All the principal arteries had important stenoses. The patient underwent complete cardiac revascularization, and, sixteen months later, is free from angina. Rest and stress myocardial scintigraphy, control coronary angiography and Doppler analysis of internal mammary artery flow demonstrated normal myocardial perfusion, adequate blood flow through the grafts and good runoff in the native vessels. Hence, the authors conclude that such patients should be referred for coronary artery revascularization, since surgical results are good and the small calibre of the left coronary arteries is no contraindication.
作者报告了一例成年患者左冠状动脉主干闭锁的罕见病例，该患者有劳力性心绞痛症状。冠状动脉造影时未发现左冠状动脉主干；取而代之的是，左冠状动脉树的动脉通过一条单独的侧支血管供血，该侧支血管起自右冠状动脉开口，止于左前降支动脉主干。所有左冠状动脉口径极窄，几乎发育不全，而右冠状动脉口径正常。所有主要动脉均有严重狭窄。该患者接受了完全性心脏血运重建，16个月后，心绞痛症状消失。静息和负荷心肌闪烁显像、冠状动脉造影复查以及乳内动脉血流的多普勒分析显示心肌灌注正常，移植血管血流充足，自身血管有良好的血流灌注。因此，作者得出结论，此类患者应接受冠状动脉血运重建，因为手术效果良好，左冠状动脉口径小并非禁忌证。
