冠状动脉起源于肺动脉的影像学评价
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摘要
目的:探讨不同影像学方法对冠状动脉起源于肺动脉的诊断及术后随访价值。方法:分析经手术证实的11例冠状动脉起源于肺动脉患者的影像学及临床资料。术前11例患者均行胸X线片、超声心动图检查,10例行冠状动脉CTA检查,4例冠状动脉造影检查,1例右心导管检查。术后所有患者行胸部X线和超声检查,2例行冠状动脉CTA,1例行心脏MR检查。结果:11例患者婴儿组7例,儿童1例,成人组3例。左冠状动脉起源于肺动脉10例,右冠状动脉起源于肺动脉1例。所有患者均存在心脏杂音。术前超声确诊7例,4例误诊;10例CTA均术前诊断明确;4例行冠状动脉造影并确诊。术前LVEF(43±6.4)%,术后LVEF(55.8±8.8)%,差异有统计学意义(P<0.05)。随访中位时间7个月(1～34个月),术后1个月婴幼儿组1例死亡,其余患者随访无术后并发症发生。结论:冠状动脉CTA可作为诊断冠状动脉起源于肺动脉的首选检查方法,各种影像学方法综合应用,是冠状动脉起源于肺动脉诊断及随访的基础。
Objective: To evaluate the value of different imaging method in the diagnosis and postoperative follow-up of anomalous origin of the coronary artery from the pulmonary artery(ACAPA). Methods: The imaging and clinical data of 11 patients with ACAPA were analyzed. X-ray, echocardiography were performed on all 11 patients before operation, 10 patients underwent coronary artery CTA, 4 underwent coronary angiography, and 1 patient underwent right heart catheterization. All the patients underwent X-ray and echocardiography, 2 patients underwent coronary artery CTA and 1 patient underwent cardiac MRI for postoperative follow-up. Results: Among the 11 patients(7 infants, 1 child, and 3 adults), 10 cases were anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA), and 1 case was anomalous origin of the left coronary artery from the pulmonary artery(ARCAPA). Heart murmurs were present in all patients. Before the surgery, seven cases were diagnosed correctly by echocardiography, and 4 cases were misdiagnosed. Ten cases were diagnosed correctly by coronary CTA,and 4 cases underwent coronary angiography. Preoperative LVEF(43±6.4)%, postoperative LVEF(55.8±8.8)%, the difference was statistically significant(P<0.05). The follow-up median time was 7 months(1 to 34 months). One patient died within 1 month after surgery in the infant group, and there were no post-operative complications for the rest of the patients more than 1 month after surgery. Conclusions: Coronary CTA can be used as the first choice for the diagnosis of ACAPA. The comprehensive application of various imaging method is the basis of diagnosis and follow-up for ACAPA.
Objective: To evaluate the value of different imaging method in the diagnosis and postoperative follow-up of anomalous origin of the coronary artery from the pulmonary artery(ACAPA). Methods: The imaging and clinical data of 11 patients with ACAPA were analyzed. X-ray, echocardiography were performed on all 11 patients before operation, 10 patients underwent coronary artery CTA, 4 underwent coronary angiography, and 1 patient underwent right heart catheterization. All the patients underwent X-ray and echocardiography, 2 patients underwent coronary artery CTA and 1 patient underwent cardiac MRI for postoperative follow-up. Results: Among the 11 patients(7 infants, 1 child, and 3 adults), 10 cases were anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA), and 1 case was anomalous origin of the left coronary artery from the pulmonary artery(ARCAPA). Heart murmurs were present in all patients. Before the surgery, seven cases were diagnosed correctly by echocardiography, and 4 cases were misdiagnosed. Ten cases were diagnosed correctly by coronary CTA,and 4 cases underwent coronary angiography. Preoperative LVEF(43±6.4)%, postoperative LVEF(55.8±8.8)%, the difference was statistically significant(P<0.05). The follow-up median time was 7 months(1 to 34 months). One patient died within 1 month after surgery in the infant group, and there were no post-operative complications for the rest of the patients more than 1 month after surgery. Conclusions: Coronary CTA can be used as the first choice for the diagnosis of ACAPA. The comprehensive application of various imaging method is the basis of diagnosis and follow-up for ACAPA.
引文
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[15] Radke PW,Messmer BJ,Haager PK,et al.Anomalous origin of the right coronary artery:preoperative and postoperative hemodynamics [J].Ann Thoracic surg,1998,66(4):1444-1449.
[16] Schmid M,Achenbach S,Ludwig J,et al.Visualization of coronary artery anomalies by contrast-enhanced multi-detector row spiral computed tomography [J].Int J Cardiol,2006,111(3):430-435.
[17] 王诚,凌坚,赵世华,等.冠状动脉起源于肺动脉的影像学研究 [J].中华放射学杂志,2004,38(7):690-693.
[18] 许建屏,郭宏伟,胡盛寿,等.冠状动脉异常起源于肺动脉的外科治疗 [J].中华外科杂志,2006,44(22):1525-1528.
[2] Parasramka S,Dufresne A.Anomalous origin of right coronary artery from pulmonary artery presenting as chest pain in a young man [J].J Cardiol Cas,2012,5(1):e20-e22.
[3] Yamanaka O,Hobbs RE.Coronary artery anomalies in 126,595 patients undergoing coronary arteriography [J].Cathet Cardiovasc Diagn,1990,21(1):28-40.
[4] Baltaxe HA,Wixson D.The incidence of congenital anomalies of the coronary arteries in the adult population [J].Radiology,1977,122(1):47-52.
[5] Alexander RW,Griffith GC.Anomalies of the coronary arteries and their clinical significance [J].Circulation,1956,14(5):800-805.
[6] Roberts WC.Major anomalies of coronary arterial origin seen in adulthood [J].Am Heart J,1986,111(5):941-963.
[7] Villa AD,Sammut E,Nair A,et al.Coronary artery anomalies overview:The normal and the abnormal [J].World J Radiol,2016,8(6):537.
[8] Tkebuchava T,Carrel T,von Segesser L,et al.Repair of anomalous origin of the left coronary artery from the pulmonary artery without early and late mortality in 9 patients [J].J Cardiovasc Surg (Torino),1992,33(4):479-485.
[9] Williams IA,Gersony WM,Hellenbrand WE.Anomalous right coronary artery arising from the pulmonary artery:a report of 7 cases and a review of the literature [J].Am Heart J,2006,152(5):1004.e1009-1004.e1017.
[10] 阴赪茜,李志忠,程宇彤,等.成人冠状动脉异常起源于肺动脉的临床分析 [J].心肺血管病杂志,2014,(3):360-363.
[11] Lange R,Vogt M,Horer J,et al.Long-term results of repair of anomalous origin of the left coronary artery from the pulmonary artery [J].Ann Thorac Surg,2007,83(4):1463-1471.
[12] Wesselhoeft H,Fawcett JS,Johnson AL.Anomalous origin of the left coronary artery from the pulmonary trunk.Its clinical spectrum,pathology,and pathophysiology,based on a review of 140 cases with seven further cases [J].Circulation,1968,38(2):403-425.
[13] Brezinski DA,Harrison JK,Hanson MW,et al.Ischemic hibernating myocardium demonstrated by positron emission tomography in anomalous origin of the left coronary artery from the pulmonary artery [J].Am Heart J,1994,128(1):181-185.
[14] Frescura C,Basso C,Thiene G,et al.Anomalous origin of coronary arteries and risk of sudden death:a study based on an autopsy population of congenital heart disease [J].Hum Pathol,1998,29(7):689-695.
[15] Radke PW,Messmer BJ,Haager PK,et al.Anomalous origin of the right coronary artery:preoperative and postoperative hemodynamics [J].Ann Thoracic surg,1998,66(4):1444-1449.
[16] Schmid M,Achenbach S,Ludwig J,et al.Visualization of coronary artery anomalies by contrast-enhanced multi-detector row spiral computed tomography [J].Int J Cardiol,2006,111(3):430-435.
[17] 王诚,凌坚,赵世华,等.冠状动脉起源于肺动脉的影像学研究 [J].中华放射学杂志,2004,38(7):690-693.
[18] 许建屏,郭宏伟,胡盛寿,等.冠状动脉异常起源于肺动脉的外科治疗 [J].中华外科杂志,2006,44(22):1525-1528.