儿童冠状动脉高位开口49例

Clinical analysis of 49 children with high take - off coronary artery

目的探讨儿童冠状动脉（冠脉）高位开口的临床特点及治疗转归。方法对2009年4月至2012年12月在首都医科大学附属北京儿童医院住院的49例冠脉高位开口患儿的临床表现、实验室检查及治疗转归进行系统性回顾分析。结果49例患儿中，男34例，女15例；年龄1岁1个月～17岁2个月[（9．28±4．42）岁]；均符合64排心脏CT示任意一侧冠脉起源于窦管交界处上方1．0cm以上。其中左冠脉高位开口38例，右冠脉高位开口7例，双侧冠脉高位开口4例；主诉为胸痛（22例，44．90％），胸闷或长出气（13例，26．53％），活动耐力下降（7例，14．29％），乏力（5例，10．20％），心悸（3例，6．21％），晕厥（1例，2．04％）；心电图表现为ST—T改变、房室传导阻滞、窦性心动过速、病理性Q波、期前收缩、束支阻滞；超声心动图发现左心室扩大14例，其中2例患儿射血分数〈60％。经住院治疗10d后比较，临床症状上胸痛、胸闷或长出气缓解差异有统计学意义（P〈0．05），而心电图表现及超声心动图改变比较差异无统计学意义。49例患儿中39例随访至1年，出院3个月后有6例ST—T改变恢复正常；出院6个月后有10例ST—T改变恢复正常；出院1年后有17例ST—T改变恢复正常。结论冠脉高位开口是一种罕见的冠脉畸形，其导致的心肌缺血可有多种临床表现，心电图亦可见多种异常表现，少部分可见左心室扩大，临床上易与心肌炎、心肌损害混淆。经系统治疗后，患儿症状可明显改善，但心电图、超声心动结果短期内恢复不明显，需长期观察治疗转归。

Objective To observe the clinical characteristics and prognosis in children with high take -off coronary artery. Methods The clinical characteristics, laboratory examinations and prognosis were retrospectively ana- lyzed in 49 children with high take - off coronary artery who had been admitted to Beijing Children＇s Hospital Affiliated to Capital Medical University from April 2009 to December 2012. Results Among 49 medical records of children with high take- off coronary artery,34 cases were male and 15 cases were female,with a mean age of （9.28 ±4.42） years old, and the youngest patient was 13 months old, and the oldest patient was 17 years and 2 months old. The 64 - section multidetector CT angiography of all patients showed one or both coronary arteries originated from 1.0 cm higher than the junction area of sinus and aorta,including 38 high take - off of the left coronary artery,7 high take - off of the right coronary artery and 4 high take - off of both coronary arteries. The chief complaints of the patients included chest pain （22 cases ,44.90% ）, chest tightness （ 13 cases, 26.53 % ）, declining of exercise tolerance （7 cases, 14.29% ）, fatigue （5 cases, 10.20% ）, palpitation （3 cases, 6.21% ）, syncope （ 1 case, 2.04% ）. Electrocardiogram （ECG） of those pa- tients showed ST - T changes, atrioventricular block, sinus tachycardia, pathological Q - wave, proiosystole and bundle branch block. Ultrasonic cardiogram （UCG） indicated 14 patients with the enlarged left ventricle, including 2 patients with ejection fraction lower than 60%. After 10 days hospitalization, the anesis of chest pain and chest tightness were significantly different statistically（ P 〈 0.05）, but there was no significant difference in ECG and UCG. Thirty - nine out of 49 children were followed for 1 year. After 3 months,6 patients with ST - T problem showed normal ST - T segment. After 6 months, 10 patients with ST- T problem showed normal ST -T segment. After 1 year, 17 patients with ST- T problem showed normal ST - T segment. Conclusions High take - off coronary artery is a rare malformation of the coronary artery, which can cause myocardial ischemic,leading to multiple clinical manifestations and may result in ECG changes and the left ventricle enlargement. High take - off coronary artery can be confused with myocarditis and myocar- dial lesion clinically. Patients receiving systemic treatment may have their symptoms released, but ECG and UCG may not relieve in a short term. Patients with high take - off coronary artery need lon~ - term observation.