左冠状动脉异常起源于肺动脉的诊断和外科治疗

Diagnosis and surgery of left coronary artery abnormally originating from pulmonary artery (10 cases reports)

目的总结先天性左冠状动脉异常起源于肺动脉的临床特点、诊断和外科治疗经验。方法1993年7月至2005年10月,外科治疗10例左冠状动脉异常起源于肺动脉病人,其中男5例,女5例;年龄13d^40岁。术前均经超声心动图和心导管造影检查明确诊断。单纯左冠状动脉异常起源于肺动脉者3例,合并二尖瓣关闭不全6例,同时合并二尖瓣关闭不全及左心室心尖部室壁瘤1例。行异常冠状动脉结扎4例,在体外循环下行肺动脉内隧道成形术3例,升主动脉左冠状动脉开口植入术3例;同期行二尖瓣成形5例,室壁瘤切除1例。结果早期死亡1例。随访1个月~11年。1例因严重二尖瓣关闭不全而于第1次术后16个月再行二尖瓣置换术,余者无心肌缺血或梗死、残余分流和晚期死亡,心功能恢复到I级。结论左冠状动脉异常起源于肺动脉者存在明显的血流动力学和心血管形态学改变,应尽早确诊、尽快手术治疗,适当的手术方法是取得良好外科手术疗效的关键。

Objective To summarize clinical characteristics, diagnosis and surgery of abnormally origination of left coronary artery fi＇om the pulmonary artery. Methods Clinical data of 10 patients with left coronary artery abnormally originating fi＇om pulmonary artery were analyzed, including 5 men and 5 wowen, aged from 13 to 40 years. Definite diagnosis was made by ultrasonic cardiogram （UCG） and cardiac catheter examination. Three eases were simply abnormal origination, six cases combined with MI, and one case combined with both MI and venatrieular aneurysm of left ventrieular apex. Ligation of the abnonnal coronary artery was done in four patients, three were given pulmonary artery inner tunnel platy under extmcorporeal circulation. Open implantation of left coronary artery to ascending aorta were done in 3 patients, while plasty of mitral valve were peffomaed in 5 and ventricular aneurysm resection in 1. Results One patient died postoperatively. The follow-up ranged from I month to ll years. One patient received replacement of mitral valve 16 months after first surgery due to severe MI. All the followed-up patienats presented no myocardial iseheania or infairction, no residual shunt or late death. Cardiac function was rehabilitated to grade Conclusion Obvious blood dynamics and cardiovacular morphology changes existed in patients with left coronary artery abnormally originating from pulmonary artery. Early diagnosis and surgery should be done. Proper surgical approach is the key to success.