冠状动脉异常起源于肺动脉的外科治疗  

Results of surgical correction in patients with anomalous origin of the coronary artery from the pulmonary artery

作　　者：许建屏[1] 郭宏伟[1] 胡盛寿[1] 孙立忠[1] 宋云虎[1] 孙寒松[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京阜外心血管病医院心外科,100037

出　　处：《中华外科杂志》2006年第22期1525-1528,共4页Chinese Journal of Surgery

摘　　要：目的总结冠状动脉异常起源于肺动脉的外科治疗经验及疗效随访分析。方法从1999年4月至2005年8月共对12例冠状动脉异常起源于肺动脉的患者进行了外科治疗，其中左冠状动脉起源异常8例，右冠状动脉起源异常4例。异常起源的冠状动脉直接吻合到主动脉9例，应用Takeuchi技术，即肺动脉内隧道重建冠状动脉3例。有7例左冠状动脉起源异常的患者，因中、重度二尖瓣关闭不全同期行二尖瓣成形；1例合并房间隔缺损的右冠状动脉起源异常的患者，同期在非体外循环下行房间隔缺损封堵术。结果无死亡及术后并发症，随访7～83个月，平均（32±24）个月，左冠状动脉起源异常的患者，左室舒张末径从术前的（45±7）mm减小至术后的（39±6）mm（P=0．011），左室短轴缩短率从术前的0．21±0．09增加至术后的0．35±0．06（P=0．006），7例二尖瓣成形的患者术后二尖瓣反流程度均减轻；所有患者活动能力正常，均无症状。结论外科治疗冠状动脉异常起源于肺动脉，需恢复2个冠状动脉系统供血；左冠状动脉起源异常的患者，术后左室功能明显改善，对中、重度二尖瓣关闭不全的患者，需同期行二尖瓣成形；外科治疗早、中期效果良好，远期结果需进一步随访。Objective To evaluate effectiveness of surgical correction in patients with anomalous origin of the coronary artery from the pulmonary artery. Methods Between April 1999 and August 2005, 12 patients with anomalous origin of the coronary artery from the pulmonary artery underwent surgical correction. There were 8 patients with anomalous origin of the left coronary artery from the pulmonary artery （ ALCAPA）, and 4 patients with anomalous origin of the right coronary artery from the pulmonary artery （ARCAPA）. Eight patients underwent direct aortic reimplantation, and 4 patients underwent a Takeuchi procedure （intrapulmonary artery baffle with an autologous pericardial patch ）. Simutaneous mitral annuloplasty was performed in 7 patients of ALCAPA with moderate and severe mitral regurgitation. One patient of ARCAPA was associated with an atrial septal defect （ASD） which was closed with an amplatzer septal occluder through right atrium under transesophageal echocardiography （TEE） without CPB. Results There were neither early and late deaths nor postoperative complications. Follow-up of all patients ranged from 7 to 83 months （mean, 32 ± 24 months ） . The left ventricular function postrepair improved from a preoperative fractional shortening （FS） of 0. 21 ± 0. 09 to 0.35 ± 0. 06 （ P = 0. 006 ） for patients with ALCAPA. Preoperative mitral regurgitation decreased in 7 patients of ALCAPA after mitral annuloplasty at the follow-up. All patients were doing well and their exercise tolerance improved to normal. They were free from symptoms. Conclusions Reestablishment of a two-coronary system is necessary for patients with anomalous origin of the coronary artery from the pulmonary artery. The left ventricular function improved after 2-coronary repair. We recommend that the simultaneous mitral annuloplasty should be performed at the time of operation for patients who have moderate and severe mitral regurgitation with ALCAPA. Surgical correction of ARCAPA and ARCAPA show good early and mid-ter

关 键 词：冠状动脉 肺动脉 外科手术 起源异常 

分 类 号：R654.2[医药卫生—外科学]