Sawaki S, Yoshioka J, Akahane K, Totsuka N, Maruyama T, Fujii N, Furuta S
Department of Cardiology, Nagano Red Cross Hospital.
Kokyu To Junkan. 1993 Jul;41(7):693-6.
Coronary ostial stenosis with otherwise normal coronary vessels occurs in patients with syphilis or Takayasu's aortitis. Iatrogenic ostial stenosis may develop as a complication of coronary angiography or after coronary perfusion at the time of cardiac surgery. Isolated ostial stenosis in the absence of these factors has been reported infrequently and its unique clinical and angiographic profile has been noted recently. Hence, it is proposed that this type of isolated ostial stenosis may represent a clinical entity distinct from the usual atherosclerotic coronary disease. We report the case of a middle-aged woman with this type of isolated coronary ostial stenosis. A 55-year-old female was admitted with the complaint of exertional chest pain, which had appeared 2 months admission and which had gradually become more frequent. The ECG on admission was normal. She had no coronary risk factor. Treadmill exercise test was stopped at stage 2 of Bruce protocol because ischemic S-T segment depression appeared in II, III, aVF, V4-V6 and she complained of a chest pain. Coronary angiography showed a 90% stenosis of the left coronary ostium with normal distal vessels. The right coronary artery was normal. A coronary artery bypass graft to the left anterior descending branch was performed uneventfully and the patient remains asymptomatic.
梅毒或高安动脉炎患者会出现冠状动脉口狭窄而冠状动脉其他部分正常的情况。医源性口部狭窄可能作为冠状动脉造影的并发症或心脏手术时冠状动脉灌注后的并发症出现。在没有这些因素的情况下，孤立性口部狭窄鲜有报道，其独特的临床和血管造影特征最近才被注意到。因此，有人提出这种类型的孤立性口部狭窄可能代表一种与常见的动脉粥样硬化性冠状动脉疾病不同的临床实体。我们报告了一例患有这种类型孤立性冠状动脉口狭窄的中年女性病例。一名55岁女性因劳力性胸痛入院，胸痛在入院前2个月出现且逐渐频繁。入院时心电图正常。她没有冠状动脉危险因素。在Bruce方案的第2阶段停止平板运动试验，因为在II、III、aVF、V4-V6导联出现缺血性S-T段压低，且她主诉胸痛。冠状动脉造影显示左冠状动脉口狭窄90%，远端血管正常。右冠状动脉正常。顺利进行了左前降支冠状动脉搭桥术，患者仍无症状。
