Takenaka T, Horimoto M, Fujiwara M
Division of Cardiology, Sapporo National Hospital, Japan.
Eur Heart J. 1993 Jan;14(1):129-31. doi: 10.1093/eurheartj/14.1.129.
A 54-year-old man suffering from effort angina pectoris had an anomalous origin of the left anterior descending coronary artery (LAD) from the right sinus of Valsalva (RSV). The anomalous LAD with a small ostium and without other significant narrowing initially ran into the interventricular septum and subsequently the anterior interventricular groove. Coronary angiography during the anginal attack induced by ergometer exercise testing revealed neither an enhanced narrowing of the LAD ostium, nor myocardial squeezing of the LAD at the interventricular septum level, nor coronary vasospasm. Myocardial ischaemia associated with an anomalous aortic origin of the LAD from the RSV is extremely rare, especially when the vessel runs a septal course. In the present case, the ostial stenosis of the anomalous LAD, probably due to developed atherosclerosis, seemed to be the most likely cause of the exertional angina.
一名患有劳力性心绞痛的54岁男性，其左前降支冠状动脉（LAD）起源异常，发自瓦尔萨尔瓦窦（RSV）右侧。异常的LAD开口较小，无其他明显狭窄，最初穿入室间隔，随后进入前室间沟。在测力计运动试验诱发的心绞痛发作期间进行冠状动脉造影，结果显示LAD开口既没有进一步狭窄，在室间隔水平也没有LAD的心肌挤压，也没有冠状动脉痉挛。LAD从RSV异常起源于主动脉而导致的心肌缺血极为罕见，尤其是当血管走行于间隔路径时。在本病例中，异常LAD的开口狭窄可能是由于动脉粥样硬化发展所致，似乎是劳力性心绞痛最可能的原因。
