X线二维成像的冠状动脉起源异常分型方法及其临床应用

Clinical application of novel classification for anomalous origin of coronary artery based on 2-dimensional x-ray imaging

目的:探讨一种新型的冠状动脉起源异常(AOCA)分型方法,以及对冠状动脉造影手术操作的指导作用。方法:LARAO分型方法是在X线二维透视下,采用左前斜和右前斜体位确定异常起源冠状动脉的开口位置,并将AOCA分为3型:I型为对侧冠状动脉开口周围型,II型为升主动脉或对侧主动脉窦前壁型;III型为其他型。采用LARAO分型对2013年我中心19例AOCA的起源位置、手术相关参数进行分析。结果:19例异常起源冠状动脉病例有5例LARAO I型(26.3%),13例LARAO II型(68.4%),而LARAO III型仅有1例(0.53%)。对侧冠状动脉开口周围和升主动脉/对侧主动脉窦前壁是AOCA的常见区域。I型AOCA的理想导管是对侧造影导管,而大多数II型患者(76.9%)最终选择AL导管完成手术。与采用LARAO分型之前的手术相比,这种分型可明显减少导管使用数量、对比剂剂量和X线曝光时间。结论:LARAO分型是一种适用于二维X线影像的新型分型方法,对AOCA的冠状动脉造影也有着良好的指导价值。

Objective：To investigate application value of a novel classification for anomalous origin of coronary artery （AOCA） based on 2-dimensional X-ray imaging in coronary angiography practice. Methods： In Aug, 2013, LARAO classification scheme was proposed to determine the spatial location of AOCA by use of left and right anterior obliques, and divides AOCA into 3 types ： type I, origin anomaly adjoining opposite coronary origin; type II, coronary artery originating from anterior wall of ascending aortic/opposite coronary sinus; type III, origin being in other rare location. Imaging data of 19 AOCA patients underwent coronary arteriography in 2013 were analyzed and the anomalous ostial sites were grouped according to LARAO classification. In order to investigate the guidance value of LARAO on coronary anteriography of AOCA, the procedural characteristics of AOCA patients was compared between angiography performed before and after LARAO classification proposal. Results： LARAO type II was the most common anomaly[ 13 patients （68. 4% ） ], followed by type I [ 5 patients （26. 3% ） ] , and type III had only 1 patient （0. 53% ）. In other word, the ＂hot＂ points of AOCA were the location near by opposite coronary origin or anterior wall of ascending aortic/opposite coronary sinus. The optimal catheter was usual opposite catheter in type I, and Amplaze L in type II. After LARAO classification was utilized in angiography practice, the used catheter number, contrast dose and radiation time were significantly decreased. Conclusion： LARAO classification, a novel classification scheme based on 2-dimensional X-ray imaging, is very helpful in guiding successful cannulation into anomalous coronary origin.