先天性冠状动脉畸形3例猝死死因分析

Primary congenital coronary artery anomalies: causes of sudden death and autopsy findings of three cases

目的探讨先天性冠状动脉畸形(CCA)的主要相关病变因素。方法回顾性分析无锡市人民医院1985-01—2014-06间尸检资料。结合文献探讨其发生的情况、病理类型、与死亡的关系以及检查方法和诊断要点。结果 CCA猝死3例均为男性,患者无明显的临床症状。尸检病理诊断:例1,先天性左冠状动脉起源于肺动脉(ALCAPA),右冠状动脉动脉瘤(囊状型),左前降支动脉瘤样扩张;例2,先天性右冠状动脉开口狭窄,左前降支肌桥,房间隔缺损;例3,先天性冠状动脉左主支、左旋支动脉瘤。结论 CCA应细致观察冠脉的特点,追踪冠脉行走路线,确定其和猝死的关系应特别慎重。

Purpose To investigate the main associated factors and pathological changes of congenital coronary anomalies （CCA）. Methods Autopsy data of 3 CCA cases were retrospectively analyzed in Wuxi People＇s Hospital Affiliated to Nanjing Medical University from January 1985 to June 2014 to reveal their occurrence, pathological type, and relationship with death, as well as examination methods and diagnostic criteria after reviewing related literatures. Results All the 3 CCA cases were male patients that did not show obvious clinical symptoms. Autopsy showed that congenital anomalous origin of the left coronary artery from the pulmonary artery （ALCAPA）, right coronary artery, aneurysm （cystic type）, left anterior descending artery aneurysm-like dilatation were found in Case 1 ; Case 2 showed congenital right coronary artery stenosis, left anterior descending artery muscle bridge, atrial septal defect; Case 3 demonstrated congenital left main coronary artery and left circumflex artery aneurysm. Conclusion To make a diagnosis of CCA, we should carefully observe the characteristics of coronary artery, track coronary routes and carefully discuss their relationship with the occurrence of sudden death.