成人先天性冠状动脉畸形的分类及其发生率

Classification and incidence of congenital coronary anomalies in adults

目的探讨成人冠状动脉(冠脉)造影人群先天性冠脉畸形(CCA)的类型及其发生率。方法2000年10月～2006年10月共1520例成人患者行冠脉造影检查,对检出有CCA患者的影像资料进行回顾性分析,并根据CCA解剖学特征进行分类。结果1520例成人患者共检出各类CCA58例,发生率3.82%。冠脉起源和分布异常26例,发生率1.71%;其中前降支和回旋支分别开口于左冠窦14例,左主干或回旋支起源于右冠窦各1例,右冠脉分别起源于升主动脉4例、左冠窦3例和无冠窦1例,单支左冠脉2例。冠脉终止异常11例,均为冠脉瘘,发生率0.72%。冠脉结构异常21例,发生率1.38%,其中心肌桥18例,回旋支发育不良2例,窦房结动脉起源于左室后支1例。本组病例未发现有冠脉间异常交通者。结论冠脉造影是诊断成人CCA的主要方法之一,按解剖学特征进行分类有助于阐明CCA类型及其发生率。

Objective To determine the pattern and incidence of congenital coronary anomalies （CCA） in adults undergoing coronary angiography. Methods The diagnostic angiographic data collected from October 2000 to October 2006 were reviewed, from which congenital coronary anomalies were found, and their angiographic features were studied. Results Among 1520 adults undergone coronary angiography, anomalous coronary arteries were found in 58 cases （3. 82%）. Depending on the anatomic characteristics of anomalous coronary arteries, these 58 cases were classified as following. Anomalies of origin and distribution were found in 26 cases （1. 71%）, among them separated origin of left anterior descending and left circumflex from left coronary sinus were found in 14 cases, left main trunk and left circumflex arising from right coronary sinus in 1 case for each, single left coronary artery in 2 cases, right coronary arteries arising from ascending aorta in 4 cases, from left coronary sinus in 3 cases, and from posterior coronary sinus in 1 case, respectively. Anomalies of coronary termination were observed in 11 cases （0. 72%）, and all of them were coronary artery fistulas. Anomalies of intrinsic coronary arterial anatomy in 21 cases （1.38%）, among them myocardial bridge in 18 cases, hypoplasia of left circumflex artery in 2 cases, and sinus node artery arising from left posterior ventricular branch in 1 case. No anomalous collateral vessels were found. Conclusion Coronary angiography is one of the important methods of detecting anomalous coronary arteries. Classification based on the anatomic characteristics can help clarify the pattern and incidence of congenital anomalies of coronary arteries in adalts.