右冠状动脉起自左冠状窦致急性冠状动脉综合征的临床表现及超声心动图漏诊分析  

Clinical features and analysis of missed diagnosis by ultrasound in patients with right coronary artery arising from left aortic sinus

作　　者：王欣 刘晓伟[1] 韩建成[1] 张宏凯 何怡华[1] WANG Xin;LIU Xiaowei;HAN Jiancheng;ZHANG Hongkai;HE Yihua(Department of Fetal Heart Disease Maternal Fetal Medicine Research Important Laboratories in Beijing,Beijing Anzhen Hospital,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所,胎儿心脏病母胎医学研究北京市重点实验室,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所医学影像科,100029

出　　处：《心肺血管病杂志》2019年第10期1045-1048,1055,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家重点研发计划(2018YFC1002300)

摘　　要：目的:总结右冠状动脉异常起源于左冠状窦(ARCA-L)致急性冠状动脉综合征临床表现并分析超声漏诊原因以提高其检出率。方法:回顾性分析及总结19例ARCA-L患者的临床及影像资料,总结超声漏诊原因并随访其预后。结果:ARCA-L患者19例,男性14例,入院平均年龄(56.1±8.4)岁,其急性冠状动脉综合征类型包括:静息型心绞痛6例、恶化型心绞痛10例、急性非ST段抬高型心肌梗死2例、急性ST段抬高型心肌梗死1例。所有患者均经冠状动脉造影确诊,7例检查中可见右冠状动脉近端受压、狭窄。超声心动图胸骨旁大动脉短轴切面可确诊ARCA-L,该方法检出4例,漏诊15例,漏诊率78.9%。4例患者行经皮冠状动脉介入治疗,2例行冠状动脉移植术。随访24.5(4,156)个月,1例行冠状动脉移植术,4例因心绞痛再入院治疗。结论:成人ARCA-L所致急性冠状动脉综合征以恶化型心绞痛为主,及早诊治预后较好。目前本病临床诊断以经皮冠状动脉造影及CT冠状动脉造影为主,若超声检查者提高对本病意识、仔细探查,超声心动图可成为早期诊断本病的无创性检测方法。Objective:To summarize clinical manifestations of patients with right coronary artery arising from left aortic sinus(ARCA-L),analyze missed diagnosis by ultrasound and improve diagnostic accurate rate of ARCA-L by ultrasound.Methods:Data of nineteen patients with ARCA-L,diagnosed by percutaneous transluminal coronary angioplasty(PTCA)or CT coronary angiography(CTA),were retrospectively analyzed and summarized.The causes of missed diagnosis by ultrasound were found.Outcomes of those patients were collected.Results:(1)Fourteen males and five females,who were(56.1±8.4)years old,were involved.(2)Acute coronary syndrome(ACS)of ARCA-L contained six resting angina,ten accelerating angina,two acute non-ST segment elevation myocardial infarction and one acute ST-segment elevation myocardial infarction.(3)The beginning of the right coronary artery was compressed and narrow in seven cases during coronary angiography.Coronary atherosclerosis could be diagnosed in fourteen cases.(4)Parasternal aortic short axis view could identify ARCA-L.Four cases were diagnosed by ultrasound and fifteen cases were missed.(5)Four patients had percutaneous coronary interventions,and two patients underwent coronary artery bypass grafting(CABG).Followed up for 24.5(4,156)months,one patients had CABG and four patients were in hospital again because of angina.Conclusions:The main type of ACS in adults with ARCA-L is accelerating angina.Patients with early diagnosis and treatment may have good prognosis.The diagnosis of ARCA-L mainly depends on PTCA and CTA.If sonologists raise awareness of ARCA-L and examine carefully,ultrasound may be a non-invasive method to diagnose ARCA-L at early stage of disease.

关 键 词：冠状动脉起源异常 超声心动图 

分 类 号：R54[医药卫生—心血管疾病]