儿童冠状动脉异常起源于对侧窦或交界区的诊断分析  

Diagnosis and risk analysis of children’s anomalous aortic origin of the coronary artery arising from the opposite sinus or junction regionbetween left and right coronary sinus

作　　者：王伊然 丁文虹[1] 杨静[1] 莫莹[1] 王霄芳[1] 范祥明[1] WANG Yiran;DING Wenhong;YANG Jing;MO Ying;WANG Xiaofang;FAN Xiangming(Department of Pediatric Cardiology,Beijing Anzhen Hospital,Capital Medical University,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小儿心脏科,100029

出　　处：《心肺血管病杂志》2022年第2期136-141,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:提高辨识冠状动脉异常起源于对侧冠状窦(AAOCA)或左、右冠窦交界区的临床认识。方法:回顾性总结2016年1月至2020年9月,北京安贞医院明确诊断为AAOCA或冠状动脉起源于左、右冠窦交界区患儿的超声心动图(UCG)、冠状动脉CT血管造影(CCTA)及术中探查结果。结果:20例患儿发病年龄4~15岁,平均(9.9±4.2)岁,临床表现多以胸痛、头晕、晕厥起病,严重者有心肌梗死、心力衰竭、猝死,部分患儿无症状。4例左冠状动脉异常起源于右冠状动脉窦(AAORCA),9例右冠状动脉异常起源于左冠状动脉窦(AAOLCA),7例右冠状动脉起源于左、右冠状动脉窦交界区。结论:可疑或确切病史提示下,针对性的UCG检查可以筛查出绝大多数的冠状动脉起源于对侧窦或左、右冠状动脉窦交界区,精确诊断有赖于反复多次UCG或CCTA检查及术中探查证实。虽然AAOLCA患儿晕厥、猝死发生率相对高,AAORCA患儿严重心脏不良事件的发生也不容忽视。超声发现冠状动脉起源于交界区的患儿应结合病史及CCTA除外AAOCA。Objective: To improve the clinical understanding of identifying anomalous aortic origin of the coronary artery arising from the opposite sinus(AAOCA) or junction region between left and right coronary sinus. Methods: The clinical features, electrocardiogram, ultrasound cardiography(UCG),coronary computed tomography angiography(CCTA) and intraoperative exploration of 26 children with AAOCA or coronary artery originating from the junction region between left and right coronary sinus were retrospectively summarized in Beijing Anzhen Hospital from January 2016 to September 2020. Results:The age of onset of 20 children was 2 months to 15 years, with an average of(8.4±4.9) years old. The clinical features were mostly chest distress, chest pain, dizziness and syncope. The severe cases included myocardial infarction, heart failure, sudden death.Some children are asymptomatic. There are 4 cases of anomalous aortic origin of the left coronary artery arise from left sinus(AAOLCA), 9 cases of anomalous aortic origin of the right coronary artery arise from left sinus(AAORCA), 7 cases of right coronary artery originating from the junction region between left and right coronary sinus. Conclusions: Based on suspicious or exact medical history, targeted UCG can screen out most of the AAOCA or coronary artery originating from the junction region between left and right coronary sinus. Precise diagnosis depends on repeated UCG or CCTA and intraoperative exploration. Although the incidence of syncope and sudden death in children with AAOLCA is relatively high,the occurrence of serious adverse cardiac events in children with AAORCA should not be ignored. Patients with coronary artery originating from the junction region between left and right coronary sinus diagnosed by UCG should be judged based on the medical history and CCTA in order to exclude AAOCA.

关 键 词：冠状动脉 起源异常 诊断 儿童 

分 类 号：R54[医药卫生—心血管疾病]