心电图诊断左冠状动脉异常起源于肺动脉的应用价值

Application value of electrocardiogram in diagnosing anomalous origin of left coronary artery from pulmonary artery

目的评估心电图在诊断左冠状动脉异常起源于肺动脉(anomalous origin of left coronary artery from pulmonary artery,ALCAPA)患者中的应用价值。方法收集2004年12月至2016年9月在武汉亚洲心脏病医院住院,经双源计算机断层摄影术诊断且手术证实的ALCAPA患者16例,将其分为<12个月组即婴儿组(4例)及>12个月组(12例),并分析其临床表现及心电图特征。结果 <12个月组患儿主要表现为哭闹、吸奶费力等,>12个月组主要表现为胸痛、腰背痛等;两组均可在心尖部或胸骨左缘第4肋间闻及杂音。两组Ⅰ、a VL导联异常Q波伴ST-T改变的发生率均较高,且差异无统计学意义(P>0.05);<12个月组V_5、V_6导联T波倒置的发生率明显高于>12个月组,且差异有统计学意义(P<0.05)。结论ALCAPA的心电图特征是Ⅰ、a VL导联出现异常Q波伴ST-T改变;<12个月患儿缺血面积大时可出现V_5、V_6导联T波倒置。心电图特征性改变结合体格检查,有助于ALCAPA的诊断。

Objective To evaluate the application value of electrocardiogram（ECG） in diagnosing anomalous origin of left coronary artery from pulmonary artery（ALCAPA）. Methods Sixteen ALCAPA patients were enrolled in our study who had admitted in Wuhan Asia Heart Hospital from December 2004 to September 2016. They were diagnosed with ALCAPA by dual source computed tomography and confirmed by surgery. Theses patients were classified into group A（〈12 months, 4 cases） and group B（〉12 months, 12 cases）, and their clinical manifestations and ECG features were analyzed. Results Crying and hard sucking were mainly observed among infants in group A while chest pain and backache were primary symptoms of group B. Patients in both of the two groups could be heard cardiac souffle in the apex of heart and between the fourth rib of the edge of left sternum. The incidences of abnormal Q wave and ST-T change in lead Ⅰ and aVL were both high in the two groups, with no statistically significant differences（P〉0.05）. However, the incidence of T wave inversion in lead V5and V6 in group A was significantly higher than that in group B, with statistically significant difference（P〈0.05）. Conclusion ECG of ALCAPA is characterized by abnormal Q wave complicating ST-T changes in lead Ⅰ and aVL. T wave inversion in lead V5 and V6 indicates serious myocardial ischemia among infants under 12 months. A combination of characteristic changes of ECG and physical examination is helpful for the diagnosis of ALCAPA.