冠状动脉起源于肺动脉的超声诊断研究

Echocardiographic Study of Anomalous Origin of Coronary Artery From the Pul monary Trunk

目的：冠状动脉起源于肺动脉是一种罕见的先天性畸形，以左主干爱累多见，患者多夭折于婴幼儿期，存活至童年乃至成年仍有猝死的可能。早期诊治尤为重要。本文探讨超声心动图检出该病的可行性。方法：分析５例左主干起源于肺动脉病例的二维超声心动图（２ＤＥ）和彩色多普勒血流显像（ＣＤＦＩ）的发现。其诊断经心血管造影及手术证实。结果：５例均有左室增大，右冠状动脉增宽但起源正常，左主干增宽与主动脉左窦不连接，可探及其在肺动脉干后部的开口；ＣＤＦＩ检出了肺动脉中部的双期连续性血流，其中４例检出了室间隔右缘与之伴行的左右冠状动脉间的交通支。结论：该病具特征性的２ＤＥ与ＣＤＦＩ改变，采用综合超声技术可做出诊断或提示性诊断。

Objective:Anomalous coronary artery origin ating from the pulmonary artery is one of the rare congenital anomalies,usually affecting the left main coronary artery(LMC).Most of the patients die in infancy and those survived to childhood or adulthood may have risk of sudden death. Early diagnosis and surgical intervention are very importaint.This study was aimed to investigate the feasibility of echocardiography in detecting this anomaly.Methods:Two dimensional echocardiography(2DE)and color Doppler flow imaging(CDFI)of five cases with LMC arising from the pulmonary trunk were analysed. The diagnosis was confirmed by angiography and on operation.Results:In all of the five cases,the left ventricular dimension increased, right coronary artery dilated but still originated from right aortic sinus,LMC also dilated but not from the left aortic sinus. The origin of LMC arising form the main pulmonary artery and shunt flow from LMC to the pulmonary artery were identified by 2DE and CDFI.Collaterals of the coronary artery with the right side of interventricular septum were detected in four cases.Conclusion:Definite or suggestive diagnosis can be made by comprehensive echocardiography based on characteristic fingdings on 2DE and CDFI in patients with this anomaly.