左冠窦开口的右冠状动脉CTA表现及临床意义  

CTA features and clinical significance of right coronary artery originating from the left coronary sinus

作　　者：李荣先[1] 陈琦 袁明远[1] 赵志宏 宁忠平[2] 李新明[2] 徐鹏举 黄健峰 LI Rong-xian;CHEN Qi;YUAN Ming-yuan(Department of Radioloy,Zhoupu Hospital,Shanghai University of Medicine&Health Sciences,Shanghai 201318,China)

机构地区：[1]上海健康医学院附属周浦医院放射科,上海201318 [2]上海健康医学院附属周浦医院心内科,上海201318 [3]复旦大学附属中山医院放射科,上海200032

出　　处：《放射学实践》2019年第11期1228-1231,共4页Radiologic Practice

基　　金：上海浦东新区科经委民生项目(PKJ2017-Y39);上海市卫健委面上项目(201740299);上海健康医学院协同创新项目(SPCI-18-17-001)

摘　　要：目的:总结起源于左冠窦的右冠状动脉的CTA及临床表现,分析其开口类型、走行路径及临床意义。方法:搜集右冠状动脉起源于左冠窦的121病例,分析其开口类型、狭窄部位与走行特点并与临床表现对照,分析不同类型的CTA与临床表现差异。结果:开口于左冠状窦的右冠状动脉有以下几种开口类型和走行路径,分别是单独左冠窦开口111例(91.73%)、与左主干共同开口7例(5.78%)和单独左冠窦上开口3例(2.49%)3种类型;有主肺动脉间110例(90.91%)、主动脉与右室流出道间11例(9.09%)两种走行。单独左冠窦开口类型在开口狭窄率和起始段狭窄率分别是51.35%(57/111)和41.44%(46/111)与其它开口类型对比差异有统计学意义(P<0.001)。11例心绞痛和29例心律失常患者均发生于单独左冠窦开口类型,与其它类型对比差异有统计学意义(P<0.001)。结论:右冠状动脉左冠窦开口有左冠窦单独开口、左冠窦上单独开口和与左主干共同开口3种不同开口类型,主动脉肺动脉间和主动脉右室流出道间两种不同的走行路径。右冠状动脉单独左冠窦开口且主肺动脉间走行路径是最常见且有临床风险的类型。Objective:To summarize the CTA features and clinical manifestations of the right coronary artery originating from the left coronary sinus(RCAOFLCS),and to analyze its ostial type,route and clinical significance.Methods:One hundred and twenty-one cases of RCAOFLCS were collected.The ostial type,location of stenosis and ruute were compared with the clinical characteristics.The differences between different types of RCAOFLCS on CTA and clinical manifestations were statistically analyzed.Results:RCAOFLCS presented 3 different ostial types including isolated left sinus opening(n=111,91.73%),common openings with left main branch(n=7,5.78%),isolated left supracoronay sinus opening(n=3,2.49%)and two routes,including route between the aorta and the pulmonary artery(n=110,90.91%),route between the aorta and the right ventricular outflow tract(n=11,9.09%).The stenosis rate of the ostial and the and the initial segment were 51.35%(57/111)and 41.44%(46/111)respectively in isolated left sinus opening type,which were significantly different from other opening types(P<0.001).Eleven patients with angina pectoris and 29 patients with arrhythmia all occurred in the isolated left coronary sinus opening type,which was significantly different from other types(P<0.001).Conclusions:RCAOFLCS presented 3 different ostial types including isolated left sinus opening,common openings with left main branch,isolated left supracoronay sinus opening and two routes,including route between the aorta and the pulmonary,route between the aorta and the right ventricular outflow tract.The isolated left sinus opening type and the route path between aorta and pulmonary artery were the most common types with and clinical risky.

关 键 词：右冠状动脉 异常开口 异常路径 CT血管成像 左冠窦 

分 类 号：R814.42[医药卫生—影像医学与核医学] R322.12[医药卫生—放射医学]