左冠状动脉异常起源于右冠窦致心原性晕厥一例  

Cardiac Syncope Caused by Anomalous Origin of the Left Coronary Artery From the Right Coronary Sinus:a Case Report

作　　者：陈银花 陈勇 杨菲 于海迪 尹昳丽 张洪英 何胜虎 许晓兰 CHEN Yinhua;CHEN Yong;YANG Fei;YU Haidi;YIN Yili;ZHANG Hongying;HE Shenghu;XU Xiaolan(Department of Echocardiography,Northern Jiangsu People's Hospital Affiliated to Yangzhou University,Yangzhou 225001,China;Department of Radiology,Northern Jiangsu People's Hospital Affiliated to Yangzhou University,Yangzhou 225001,China;Department of Cardiology,Northern Jiangsu People's Hospital Affiliated to Yangzhou University,Yangzhou 225001,China;Department of Intensive Care Medicine,Northern Jiangsu People's Hospital Affiliated to Yangzhou University,Yangzhou 225001,China)

机构地区：[1]扬州大学附属苏北人民医院超声心动图科,扬州225001 [2]扬州大学附属苏北人民医院影像科,扬州225001 [3]扬州大学附属苏北人民医院心内科,扬州225001 [4]扬州大学附属苏北人民医院重症医学科,扬州225001

出　　处：《中国循环杂志》2023年第9期968-971,共4页Chinese Circulation Journal

摘　　要：左冠状动脉异常起源于右冠窦属于冠状动脉异常起源于主动脉的一种先天性心血管畸形,是一种可致运动性晕厥,甚至猝死的冠状动脉畸形,患者平时可无明显症状,易被临床忽视,运动可诱发恶性心血管事件发生。本文报道1例表现为运动时晕厥随后心脏骤停的青少年患者,入院初始诊断为暴发性心肌炎,之后通过超声心动图以及超声二维斑点追踪显像、冠状动脉CT血管造影检查、心脏磁共振成像等多模态影像最终诊断为左冠状动脉异常起源于右冠窦伴壁内走行,行左冠状动脉去顶术,术后恢复良好,随访17个月未再发生恶性心血管事件,NYHA心功能分级维持在Ⅱ级。Anomalous origin of the left coronary artery from the right coronary sinus is a congenital cardiovascular malformation belonging to anomalous aortic origin of a coronary artery(AAOCA),which is a coronary artery malformation that can lead to exercise syncope and even sudden cardiac death.Patients may have no symptoms at rest,which can be easily ignored.We report a case of an adolescent patient,who presented with syncope during exercise followed by cardiac arrest and was initially diagnosed with fulminant myocarditis.After multimodal imaging of echocardiography,ultrasound two-dimensional speckle tracking imaging,coronary arterial CT angiography,cardiac magnetic resonance imaging,the patient was diagnosed as anomalous origin of the left coronary artery from the right coronary sinus with intramural course."Left coronary surgical unroofing"was performed,and the postoperative recovery was well.During the 17 months follow-up,no malignant cardiovascular events occurred,and NYHA cardiac function grade remained at gradeⅡ.

关 键 词：冠状动脉起源异常 晕厥 青少年 

分 类 号：R54[医药卫生—心血管疾病]