冠状动脉起源异常的冠状动脉造影分析

Angiographic study of anomalous coronary artery origin

目的 探讨冠状动脉起源异常（anomalous origin of coronary artery,AOCA）的冠状动脉造影特征及其临床意义.方法 2000年10月～2006年12月在我院行冠状动脉造影的患者1560例,栓出有AOCA患者29例,并对其临床资料进行回顾性分析.结果 29例AOCA患者检出率为1.9%,其中23例（79.3%）为良性AOCA,包括：前降支和回旋支分别开口于左冠窦15例,回旋支起源于右冠窦3例,右冠状动脉起源于无冠窦1例和高位开口于升主动脉4例;6例（20.7%）为有潜在临床危险AOCA,分别为左主干起源于右冠窦1例,单支左冠状动脉2例,右冠状动脉起源于左冠窦3例.起源异常冠状动脉有明显狭窄患者9例（31.0%）,但仅2例为狭窄只累及起源异常动脉.结论 AOCA无特征性临床表现,通常在冠状动脉造影时被发现;某些类型有导致严重心脏事件的潜在危险.AOCA与冠状动脉狭窄无相关性.

Objective To explore the angiographic characteristics and the clinical significance of anomalous origin of coronary artery（AOCA）. Methods The clinical data of 29 patients with AOCA （1.9% incidence） identified from 1 560 patients undergoing coronary angiography between October 2000 and December 2006 were reviewed retrospectively. Results Of the 29 patients, 23 （79.3%） had benign AOCA, including： separate origins of left anterior descending branch and left circumflex branch from left coronary sinus in 15 cases,origin of left circumflex branch from right coronary sinus in 3 cases, origin of right coronary arteries from posterior coronary sinus in 1 case and from ascending aorta in 4 cases. Six patients （20.7%） had potentially serious AOCA, of which, 1 was left main trunk from right coronary sinus, 2 were single left coronary arteries, and 3 were right coronary arteries from left coronary sinus. Nine patients（31.0%） had significant atherosclerotic diseases in the anomalous coronary artery, but only the anomalous vessels were involved in 2 cases. Conclusion AOCA are usually casual findings of diagnostic angiographic studies without clinical manifestations, and some may lead to potentially serious cardiac events. AOCA do not appear to be associated with an increased risk of coronary atherosclerotic stenosis.