左前斜位冠状动脉造影显示右冠状动脉异位开口位置分布特点

Distribution of anomalous position of right coronary ostium at left anterior oblique in coronary angiography

目的:探讨右冠状动脉(右冠)异常起源患者的冠脉造影特点、开口分布规律,以进一步改进造影技术。方法:2015年5月至2017年5月复旦大学附属中山医院心内科冠脉造影患者共24 861例,筛选右冠异常起源者。取冠脉造影时左前40°~45°的主动脉根部为一个假想平面,将其分为四个象限,分析右冠异常起源情况、图像特点及造影的技术要点。结果:右冠异常起源者147例,均成功找到异位开口,并完成选择性冠状动脉造影。147例患者中,左冠窦起源67例(45.6%,A型),左冠窦上方升主动脉起源48例(32.7%,B型),右冠窦上方升主动脉起源32例(21.7%,C型)。开口于左冠窦及左冠窦上缘患者造影图像呈现"海鸥征"和"羊角征"的特殊征象。部分影像显示左冠窦或右冠窦上方升主动脉起源的病例实际上也开口于左冠窦内。结论:右冠状动脉的异位开口最常见于左冠窦,其次是高位主动脉壁,右冠窦上方相对少见。

Objective:To explore the angiographic distribution of the anomalous ostium of right coronary artery(RCA)and improve the technical tips for catheter incubation during right coronary angiography.Methods:A total of 24 861 patients who underwent coronary angiography in Zhongshan Hospital,Fudan University from May 2015 to May 2017 were reviewed,and the cases with anomalous RCA origin were identified.The aortic root at left-anterior oblique 40°-45°view during coronary angiography was set as an imaginary plane,which was divided into four quadrants.The ostia distributions of anomalous RCAs,the image features and the technical essentials were analyzed.Results:Totally 147 cases had anomalous RCA origin and all underwent coronary angiography successfully.Among them,67 patients(45.6%,Type A)had an ectopic RCA origin from left sinus of valsalva(LSOV),48 patients(32.7%,Type B)had an anomalous RCA origin from left side of ascending aorta,and 32 patients(21.7%,Type C)had an anomalous RCA origin from right side of ascending aorta.In angiography image,some special signs named as“sea gull sign”and“horn sign”were observed in cases with anomalous RCA origin from LSOV or aortic sinus crest.Such as transposition of the heart and widened aortic root,the anomalous RCA originated from ascending aorta near coronary sinus in angiography image were actually originated from LSOV in some cases.Conclusions:The anomalous RCA arising from LSOV is the most common variation,followed by arising from ascending aorta.The RCA arising from ascending aorta above right coronary sinus is relatively rare.Understanding of the distribution regularity and image features of ectopic RCAs is helpful for coronary angiography and intervention.