儿童冠状动脉异常起源于对侧冠状窦的早期诊断

Early diagnosis of anomalous aortic origin of coronary arteries from the opposite sinus in children

目的分析10例冠状动脉异常起源于对侧冠状窦(AAOCA)患儿的临床资料,以提高对该病的早期诊断。方法总结、分析2018年6月—2019年6月本院10例AAOCA患儿临床症状、经胸超声心动图检查(TTE)和CT冠状动脉成像(CTCA)结果。结果10例AAOCA患儿均无典型运动后胸痛及晕厥,静息心电图正常,经TTE首检示AORCA 8例,AOLCA 2例,CTCA结果与TTE诊断一致,提示异常起源冠状动脉均走行于主动脉与肺动脉之间。开口狭窄7例(AORCA 5例,AOLCA 2例),主干受压狭窄4例(均为AORCA),AOLCA合并壁内段1例,起始角度为锐角8例(AORCA 6例,AOLCA 2例),AORCA同时合并高开口1例。结论对于无典型临床症状和心电图正常的儿童AAOCA,TTE可以早期正确诊断。CTCA除明确诊断外,可进一步明确冠状动脉走行位置、开口是否狭窄、起始角度以及是否合并壁内段等危险因素。AAOCA患儿应避免剧烈运动并应及时手术治疗。

Objective To analyze the clinical data of 10 children with coronary artery anomalies originating from the opposite coronary sinus(AAOCA)in order to improve the early diagnosis of the disease.Methods The clinical symptoms,transthoracic echocardiography(TTE)and CT coronary angiography(CTCA)results of 10 children with AAOCA in our hospital from June 2018 to June 2019 were summarized and analyzed.Results Eight children were diagnosed as AORCA and 2 cases were diagnosed as anomalous origin of left coronary artery from the right sinus(AOLCA)by TTE in 10 children with AAOCA.There were no typical chest pain and syncope after exercise for children.The resting electrocardiogram was normal.The results of CTCA showed that the abnormal origin of coronary artery was located between the aorta and pulmonary artery.There were 7 cases with opening stenosis(AORCA 5 cases,AOLCA 2 cases),4 cases with compression stenosis of the main artery(all AORCA),1 case with AOLCA and intramural segment,8 cases with acute angle(AORCA 6 cases,AOLCA 2 cases),and 1 case with AORCA and high opening.Conclusion TTE can be used to diagnose AAOCA in children without typical clinical symptoms and normal ECG.In addition to definite diagnosis,CTCA is more important to find abnormal origin of the coronary artery between the aorta and pulmonary artery,stenosis of the orifice,sharp starting angle and the combination of intramural segments and other risk factors,so as to avoid strenuous exercise and timely surgical treatment.