8例左冠状动脉起源于肺动脉的外科治疗探讨

Surgical Treatment of Anomalous Origin of the Left Coronary Artery from the pulmonary Artery

目的:通过对8例左冠状动脉起源于肺动脉的外科手术治疗和远期随访,探讨术前诊断、手术术式和疗效。方法:1987年8月至2013年3月,8例患者进行了手术治疗,其中7例采用肺动脉内隧道成形术,1例采用冠状动脉旁路移植术,1例患者合并二尖瓣关闭不全,同时进行了二尖瓣成形术。术前进行了ECG,、心脏超声、心导管、心脏造影等全面检查。术后随访7例,共随访327个月,平均(46.8±10.7)个月。结果:8例患者无住院死亡和严重并发症,7例随访无晚期死亡,1例患者因肺动脉内隧道缝线撕脱,导致主动脉-主肺动脉瘘,二次手术修补成功。随访患者NYHA心功能Ⅰ级,LVED平均(46..4±3.7)mm,较术前(54.4±2.8)mm明显减少(P<0.01),EF值(69.4±2.3%)较术前(59.6±2.8%)明显提高(P<0.05)。结论:左冠状动脉起源于肺动脉是一种罕见的先天性心脏病,治疗的主要原则为重建俩支冠状动脉系统并处理好合并病变。肺动脉内隧道矫治方法,简便易行,疗效满意。

Objective： To introduce the experience of surgical correction of anomalous origin of the left coronary artery from the pulmonary artery in 8 patients. Methods： 1987 Aug to 2013 Mar, 8 cases underwent surgical treatment. Intrapulmonary tunnel pro- cedure was performed in 7 patients, coronary artery bypass grafting, using the saphenous vein, in 1 patient. Mitral valve incompe- tence was repaired in 1 patient. ECG , Eehoeardiographie and Angiographie study made in all patients for diagnosis. 7 patients were followed up, altogether follow up 327 months , mean 46. 8 ＋ 10.7 months. Results： Complications during the hospital stay. One pa- tients because of suture of intrapulmonary tunnel loose , arotery - pulmonary artery leakage happened and reoperatied successful. Cardiac function of follow - up patients was New York Heart Association function class I , mean LVMD 46. 4 ＋3.7mm, compair to pro - operation, s mean 54.4 ~ 2. 8mm shrinke evidence （P 〈 0. 01 ）, EF 69.4 ~ 2. 3% compare to pro - operation, s mean 59. 6 ＋ 2. 8% raise evidence （P 〈0. 05）o Conclusion An： anomalous origin of the left coronary artery from the pulmonary artery is a very rare congenital malfornation , correcting the anomalous origin of the left coronary artery from the pulmonary artery is to reconstruct the normal two - coronary system and the other associated disease. Interpulmonary artery tunnel operation easy to be done and the result is satisfactory.