208例儿童先天性冠状动脉起源异常临床分析  

Clinical analysis of 208 children with congenital coronary artery origin abnormalities

作　　者：甄珍[1] 董梓妍 邵艺华 那嘉[1] 李奇蕊 陈希[1] 高路[1] 袁越[1] Zhen Zhen;Dong Ziyan;Shao Yihua;Na Jia;Li Qirui;Chen Xi;Gao Lu;Yuan Yue(Department of Cardiology,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院心脏内科,北京100045

出　　处：《中国小儿急救医学》2023年第8期566-572,共7页Chinese Pediatric Emergency Medicine

摘　　要：目的了解儿童先天性冠状动脉起源异常(AOCA)的临床特点及预后转归,提高临床医生对本病的认识。方法回顾性分析首都医科大学附属北京儿童医院2014年1月1日至2019年12月31日经CT冠状动脉成像(CTCA)确诊为AOCA患儿的临床资料,分析其临床表现、辅助检查、治疗及预后。结果共纳入208例AOCA患儿,男105例,女103例,年龄(9.03±4.18)岁。157例(75.5%)患儿以胸闷、心悸、头晕、晕厥、乏力、活动耐力下降等心脏相关症状就诊,3例(1.4%)患儿为阵发哭闹、呼吸困难、发绀等不典型症状,48例(23.1%)患儿无自诉症状。59例(28.4%)患儿存在心肌损伤标志物升高,心电图异常以ST-T改变为主,共140例(67.3%)。经胸超声心动图提示27例(13%)患儿存在心脏房室内径增大,10例(4.8%)患儿心功能减低。CTCA示左冠状动脉起源异常最常见,共126例(60.6%);其次为右冠状动脉起源异常,共50例(24.0%);双侧冠状动脉起源异常最少见,共32例(15.4%)。除5例患儿行手术治疗外,余患儿均予药物保守治疗。所有患儿经治疗后均好转出院,无死亡病例。结论AOCA可造成不同程度的心肌缺血。该病临床表现多样,经胸超声心动图有一定局限性,常导致漏诊或误诊。CTCA诊断准确性高,同时可用于精准判断冠状动脉开口位置及走行。治疗应针对冠状动脉起源不同类型个体化治疗,必要时行手术治疗。Objective To describe the clinical features and prognosis of congenital anomalous origin of coronary artery(AOCA)in children to increase our understanding of the disease.Methods This retrospective study included children diagnosed with AOCA using computed tomography coronary angiography(CTCA)admitted to the Department of Cardiology,Beijing Children′s Hospital,Capital Medical University,from January 1,2014 to December 31,2019.The clinical presentations,laboratory results,imaging analyses,treatments,and prognoses of these patients were analyzed.Results A total of 208 children,including 105 boys and 103 girls,we evaluated the ages(9.03±4.18)years old with AOCA.Of these,157 cases(75.5%)presented with cardiac symptoms,such as chest tightness,palpitations,dizziness,syncope,fatigue,and decreased endurance.Three cases(1.4%)had atypical symptoms of paroxysmal crying,dyspnoea and cyanosis,and 48 cases(23.1%)were asymptomatic.Levels of serological markers of myocardial injury were elevated in 59 cases(28.4%),and 140 cases(67.3%)had predominant ST-T abnormalities on electrocardiograms.Transthoracic echocardiography identified 27 cases(13%)with cardiac enlargement and ten cases(4.8%)with left ventricular systolic dysfunction.There were 126 cases(60.6%)with the anomalous origin of the left coronary artery revealed by CTCA,50 cases(24.0%)with the anomalous origin of the right coronary artery and 32 cases(15.4%)with bilateral coronary arteries of anomalous origin.Five children underwent surgical treatment,and the remaining 203 children were treated conservatively with drugs.The whole group was successfully treated,and no death case was recorded during the follow-up period.Conclusion AOCA may cause different degrees of myocardial ischemia.Diverse clinical presentations and diagnostic limitations of transthoracic echocardiography often lead to missed diagnosis or misdiagnosis.In contrast,CTCA has high diagnostic accuracy and can be used to identify the location and course of the coronary ostia.Hence,the management of AOCA shoul

关 键 词：儿童 先天性冠状动脉起源异常 缺血性心肌损害 心源性猝死 

分 类 号：R725.4[医药卫生—儿科]