成人型左冠状动脉起源于肺动脉1例报告及文献复习  

Adult anomalous origin of left coronary artery from pulmonary artery:A case report and literature review

作　　者：郑庆霜 王鹤儒 姜国芳[1] 尹霞[1] ZHENG Qingshuang;WANG Heru;JIANG Guofang;YIN Xia(Department of Cardiovascular Disease Diagnosis and Treatment Center,First Hospital,Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院心血管疾病诊治中心,吉林长春130021

出　　处：《吉林大学学报（医学版）》2019年第2期410-413,473,共5页Journal of Jilin University：Medicine Edition

基　　金：国家自然科学基金面上项目资助课题(81670353)

摘　　要：目的:探讨左冠状动脉起源于肺动脉(ALCAPA)的发病机制、临床特点、诊断和治疗方法,提高临床医生对该疾病的认识。方法:对1例曾误诊为心内膜弹力纤维增生症(EFE)的成人型ALCAPA患者的临床资料进行回顾性分析,并结合相关文献复习。结果:患者因间断心前区疼痛、胸闷、气短2月余并加重3d入院,入院后初步诊断为心肌病(EFE所致可能性大)、心律失常-心房颤动、心功能Ⅲ级。给予相关治疗后仍有阵发性胸骨后疼痛,并出现1次心室颤动,后行冠状动脉螺旋CT血管成像(CTA)确诊为ALCAPA,于心外科行冠状动脉旁路移植术,术后恢复良好。结论:ALCAPA相对罕见,临床表现缺乏特异性,容易误诊,冠状动脉CTA是有效诊断方法,手术是首选治疗方案。Objective:To explore the pathogenesis,clinical characteristics,diagnosis and treatment methods of anomalous origin of left coronary artery from pulmonary artery(ALCAPA),and to improve the clinicians’ understanding of the disease.Methods:The clinical data of an adult patient with ALCAPA who had been misdiagnosed as endocardial fiborelastosis(EFE)were retrospectively analyzed;in the meanwhile,the related literatures were reviewed.Results:The patient admitted to hospital because of her intermittent precordial pain,chest tightness and shortness of breath,and suffered from more than 2 months,aggravated for 3 d.The patient was preliminarily diagnosed as cardiomyopathy(considering the great possibility of EFE),atrial fibrillation,NYHA Ⅲ.After treatment,paroxysmal retrosternal pain still occurred,and ventricular fibrillation occurred one time.Finally,the patient was diagnosed as ALCAPA by coronary artery CTA,and treated by coronary artery bypass grafting.After operation,the patient recovered well.Conclusion:ALCAPA is relatively rare,and its clinical manifestations lack specificity,so it is easy to misdiagnose.Coronary artery CTA is an effective diagnostic method,and operation is the first choice for its treatment.

关 键 词：冠状血管畸形 左冠状动脉起源于肺动脉 心内膜弹力纤维增生症 CT血管成像 

分 类 号：R543.3[医药卫生—心血管疾病]