左冠状动脉异常起源于肺动脉的超声心动图特点

Echocardiographic features of patients with anomalous left coronary artery from the pulmonary artery

目的探讨左冠状动脉异常起源于肺动脉（ALCAPA）患者的超声心动图特点。方法回顾性分析10例ALCAPA患者的临床资料，并与冠状动脉造影结果比较，总结其超声心动图特点。结果10例ALCAPA患者中，婴儿型3例，成人型7例。婴儿型患者均有左心室腔变大，前壁及侧壁搏幅减低。成人型患者可见右冠状动脉主干及分支扩张；室间隔内可探及以舒张期为主的连续性血流信号；左前降支供血区心肌内可见丰富血流信号。7例患者的左主干起源于肺动脉，3例患者的左回旋支起源于肺动脉，多普勒超声心动图提示舒张期肺动脉内有异常血流汇入。1例ALCAPA患者误诊为冠状动脉瘘，通过心导管造影得以确诊；1例患者多次超声心动图检查均提示左冠状动脉起源于主动脉左冠状动脉窦，造影和术中观察显示左冠状动脉起源于肺动脉有后窦。8例ALCAPA患者合并其他心血管畸形，包括房间隔缺损、室间隔缺损、心肌致密化不全等。结论左冠状动脉与肺动脉的异常连接及舒张期异常血流为ALCAPA具有确诊意义的超声心动图征象。部分患者表现不典型，应结合冠状动脉造影进行诊断。

Objective To summarize the echocardiographic features of anomalous left coronary artery from the pulmonary artery （ALCAPA）. Methods A study was performed on 10 patients with ALCAPA retrospectively and the result was compared with coronary angiography to summarize its echocardiographic features. Results Of the 10 patients with ALCAPA, there were 3 cases of infantile type and 7 cases of adult type. Left ventricular cavity was enlarged and the anterior and lateral wall motion was reduced in all patients with the infantile type ALCAPA. The trunk and branch of the right eoronary artery was enlarged in patients with the adult type, meanwhile the diastolic blood flow signal could be detected in inter-ventrieular septum and in the area supplied by the left anterior descending coronary artery. The trunk of the left coronary artery originated from the pulmonary artery in 7 patients, the left circumflex artery originated from the pulmonary artery in another 3 patients. Diastolic blood flow signal could he detected by the Doppler echocardiogram in the pulmonary artery in all patients. One patient was misdiagnosed as coronary artery fistula, and correct diagnosis was made by the coronary angiography. In 1 patient, echoeardiography examination suggested that the left coronary artery was originated from left coronary aortic sinus and angiography results showed that the left coronary artery was originated frmn the right posterior sinus of the pulmonary artery. Eight ALCAPA patients suffered from other cardiovascular abnormalities, including atrial septum defect, ventricular septal defect and noncompaction of ventricular myocardium. Conclusions Abnormal connection of the left coronary artery with pulmonary artery and diastolic blood flow are typical echocardiographic findings in patients with ALCAPA. Coronary angiography serves as an important tool for the correct diagnosis of ALCAPA.