Kaku B, Shimizu M, Yoshio H, Ino H, Mizuno S, Kanaya H, Ishise S, Mabuchi H
Second Department of Internal Medicine, School of Medicine, Kanazawa University, Japan.
Jpn Circ J. 1996 Oct;60(10):731-41. doi: 10.1253/jcj.60.731.
Anomalous origin of the coronary artery can lead to angina pectoris, acute myocardial infarction or even sudden death in the absence of atherosclerosis. However, in Japan, this anomaly is usually treated medically rather than surgically. To clarify the clinical features of anomalous origin of the coronary artery in Japanese and the prognosis of such patients who are treated medically, we reviewed 56 patients with anomalous origin of the coronary arteries. The mean age of these patients was 55.9 +/- 11.5 years. Anomalous origin of the right coronary artery from the left sinus of Valsalva was seen most frequently (78.6%). In contrast, we found no cases of anomalous origin of the left coronary artery from the right sinus of Valsalva traversing between the aorta and the pulmonary trunk. A history of syncope (14.3%) and aorta regurgitation (21.4%) was frequent and serious complications during exercise stress testing occurred in 5 patients. These patients were treated medically, such as by limiting exercise or by the oral administration of medicine. During the follow up period (mean 5.6 +/- 4.2 years), death directly related to anomalous origin of the coronary artery was not found despite the lack of surgical treatment. Our results suggest that the prognosis of these middle-aged-to-elderly patients without atherosclerosis is relatively good, despite the lack of surgical treatment.
冠状动脉异常起源可导致心绞痛、急性心肌梗死，甚至在无动脉粥样硬化的情况下引发猝死。然而，在日本，这种异常通常采用药物治疗而非手术治疗。为阐明日本冠状动脉异常起源患者的临床特征以及接受药物治疗的此类患者的预后，我们回顾了56例冠状动脉异常起源患者。这些患者的平均年龄为55.9±11.5岁。最常见的是右冠状动脉起源于左冠窦（78.6%）。相比之下，我们未发现左冠状动脉起源于右冠窦并走行于主动脉和肺动脉干之间的病例。晕厥病史（14.3%）和主动脉瓣关闭不全（21.4%）较为常见，5例患者在运动负荷试验期间出现严重并发症。这些患者接受了药物治疗，如限制运动或口服药物。在随访期间（平均5.6±4.2年），尽管未进行手术治疗，但未发现与冠状动脉异常起源直接相关的死亡。我们的结果表明, 这些无动脉粥样硬化的中老年患者，尽管未接受手术治疗，但其预后相对较好。
