经胸超声心动图诊断冠状动脉起源异常的临床价值

Coronary artery origin anomalous diagnosed by transthoracic echocardiography

目的探讨经胸超声心动图(TTE)诊断冠状动脉起源异常(CAOA)的临床应用价值。方法应用TTE对11例CAOA患者进行检查,显示冠状动脉的起源、走行、血流方向、性质、时相和速度,观察有无合并其他心血管畸形,并与冠状动脉造影和手术结果比较。结果左冠状动脉起源于肺动脉5例、起源于右冠状动脉1例,左前降支起源于右冠状动脉1例,疑诊左前降支或左回旋支起源于右冠状动脉窦1例,左前降支和左回旋支单独起源于左冠状动脉窦2例,右冠状动脉高位发出1例。其中合并右冠状动脉-右室瘘1例,卵圆孔未闭1例,二尖瓣前叶夹层动脉瘤形成伴破裂1例,继发性心内膜弹力纤维增生症3例。超声结果与冠状动脉造影和手术结果符合。结论经胸超声心动图能准确提供冠状动脉的起源、走行、血流状态等信息,具有重要的临床应用价值。

Objective To discuss the clinical value of transthoracic echocardiography （TTE） in diagnosing coronary artery origin anomalus （CAOA）. Methods Eleven patients were studied by TTE. The origin, running course, flow characteristics of coronary artery were depicted. And the results were compared with those of coronary angiography and surgery. Results Eleven CAOA were diagnosed in eleven patients： five of them had left coronary artery （LCA） originated from pulmonary artery （PA）, one LCA from right coronary artery （RCA）, one left anterior descending （LAD） from RCA, one left cumflex （LCx） from right sinus of Valsalva, two separate LAD and LCx from left sinus of Valsalva, one RCA from the ascending aorta. And one accompanied right coronary fistula, one patent foramen ovale, one mitral valve dissection aneurysm, and three endomyocardial fibrelastosis. The diagnosis of TTE were confirmed by coronary angiography and surgery. Conclusion TTE offers a simple, useful and reliable technique in diagnosing CAOA, and provides important information of the origin, running course, and flow characteristics of coronary artery, for clinic and coronary angiography.