血管造影诊断成人冠状动脉起源异常的单中心经验

Percutaneous coronary angiography in anomalous origin of coronary artery:a single center experience

目的:分析血管造影诊断成人冠状动脉起源异常(AOCA)的检出率、分布规律,并总结本中心的手术经验。方法:回顾性分析我中心2013年全年的2 067例冠状动脉(冠脉)造影患者的临床资料及手术资料,并利用一种新型分型方案(LARAO分型)对AOCA的异常起源位置、手术相关参数进行分析。结果:2 067例冠脉造影检出19例AOCA,检出率为0.92%。其中,右冠脉起源异常12例(63.2%),是最为多见的起源异常类型;6例(31.6%)为左冠脉起源异常;1例患者左右冠脉开口均异常。与正常冠脉组相比,AOCA进行血管造影所需的导管数量、对比剂剂量及X线暴露时间均明显增加。采用LARAO分型发现,对侧冠脉开口周围(Ⅰ型,占26.3%)和升主动脉/对侧主动脉窦前壁(Ⅱ型,占68.4%)是AOCA的"热点"区域。在LARAO分型提出后,AOCA进行血管造影所需导管数量、对比剂剂量及X线暴露时间明显减少。结论:尽管成人AOCA的发生率极低,但会增加血管造影手术的难度,而LARAO分型有助于在血管造影术中寻找起源异常的冠脉。

Objective：To determine the prevalence and the spatial distribution features of anomalous origin of coronary artery in adults by percutaneous coronary angiography,and to report procedural experience of the authors＇ center.Method：Clinical and procedural data of 2 067 patients who underwent coronary angiography in our center in 2013 were reviewed.Anomalous coronary origins were further classified according to LARAO classification proposed by our center in August 2013.Result：An overall of 19/2067patients（0.92%）had origin anomalies.12patients（63.2%）had an anomalous origin of the right coronary artery,6patients（31.6%）had an anomalous origin of left coronary artery,and one patient had an anomalous origin of both coronary arteries.As compared with normal coronary origins,AOCA significantly increased catheter number,contrast dose and radiation time which were used during angiography.According to LARAO classification,the area near by opposite coronary origin（LARAO type I,26.3%）and anterior wall of ascending aortic/opposite coronary sinus（LARAO type Ⅱ,68.4%）were found the most frequent locations of origin anomalies.After LARAO proposal was utilized in angiographic procedure,the needed catheter number,contrast dose and radiation time were significantly reduced.Conclusion：Although the incidence of AOCA in adults was found infrequent by percutaneous coronary angiography,it poses the technical challenges to operators.LARAO classification is an very helpful method to guiding successful cannulation into anomalous coronary origin.