基于大样本冠状动脉CT血管成像的单纯先天性冠状动脉异常研究

A study of simple congenital coronary artery anomalies based on a large-sample coronary CT angiography

目的利用大样本冠状动脉CT血管成像(CCTA)资料,探讨国人单纯先天性冠状动脉异常(CCAA)的分类与检出率,并简单总结“恶性”异常的CT表现。方法回顾性分析2009年7月至2017年1月在阜外医院行CCTA检查的165133例患者资料,对检出的单纯CCAA按照冠状动脉起源、开口数目及终点异常进行分类,并统计各类异常的检出率。起源异常包括冠状动脉起源于对侧冠状动脉窦、无冠状动脉窦、主动脉或原冠状动脉窦周围、肺动脉以及回旋支起自对角支;开口数目异常包括单支冠状动脉(SCA)、圆锥支单独开口于右冠状动脉窦、前降支与回旋支双开口;终点异常为冠状动脉瘘(CAF)。其中,冠状动脉起源于对侧冠状动脉窦、冠状动脉起源于肺动脉、SCA、多个或较大的CAF定义为“恶性”异常。结果在165133例CCTA检查中,共发现CCAA 2148例,检出率为1.301%,包括冠状动脉起源异常1302例(0.789%)、开口数目异常298例(0.181%)、终点异常548例(0.332%)。在起源异常中,检出冠状动脉起源于对侧冠状动脉窦700例(0.424%),其中179例血管开口或近段管腔受压而不同程度狭窄,7例不合并冠心病但有明确的心肌缺血或心肌梗死改变。冠状动脉起源于无冠状动脉窦、主动脉或原冠状动脉窦周围分别检出48(0.029%)、531例(0.322%)。冠状动脉起源于肺动脉共检出20例(0.012%),均为左主干起源于肺动脉,均表现为左、右冠状动脉迂曲扩张,左心室增大,5例无冠心病但有明确的心内膜下心肌缺血或心肌梗死改变。冠状动脉开口数目异常中,SCA、圆锥支单独开口于右冠状动脉窦、前降支及回旋支双开口分别检出102(0.062%)、53(0.032%)、143例(0.087%)。102例SCA中,仅有1例表现为心肌缺血且无合并冠心病。CAF共检出548例(0.332%),其中冠状动脉-肺动脉瘘检出率最高,为458例(0.277%),冠状动脉-心房瘘、心室瘘分别检出22(0.013%)、60例(0.036%),另有冠状动脉-冠状静脉瘘6例(0.004%)、冠状动脉-上腔静脉瘘2例(0.001%)。结论CCAA并不罕见,其中冠状动脉起源异常最常见,对“恶性”异常的CT表现需格外注意。

Objective To investigate the classification and prevalence of simple congenital coronary artery anomalies(CCAA)in Chinese in a large samples of coronary CT angiography(CCTA),and briefly summarize the CT characteristics of"malignant"anomalies.Methods The data of patients who had undergone CCTA from July 2009 to January 2017 and were diagnosed as simple CCAA were analyzed retrospectively.CCAA were classified according to the origination,number of orifices and termination,and the prevalence of various CCAA was statistically analyzed.Anomalous origin of coronary artery included the origin of coronary artery from the opposite coronary sinus,the non-coronary sinus,the aorta or around the primary sinus,the pulmonary artery,and left circumflex artery originated from the diagonal branch.Abnormal number of orifices included single coronary artery(SCA),right coronary artery and conus branch arising separately,and left anterior descending branch and circumflex branch arising separately.Abnormal termination was coronary artery fistula(CAF).Anomalous origin of coronary artery from the opposite sinus,anomalous origin of the coronary artery from the pulmonary artery,SCA,and multiple or large CAFs were defined as"malignant"anomalies.Results Among 165133 patients,2148(1.301%)had coronary anomalies,including 1302(0.789%)of origin anomalies,298(0.181%)of abnormal number of orifices and 548(0.332%)of abnormal termination.There were 700 cases(0.424%)with coronary artery rising from the opposite sinus,179 of which had opening or proximal lumen stenosis due to compression,7 of which had subendocardial myocardial ischemia or infarction on CCTA without coronary artery disease(CAD).The coronary arteries originated from posterior sinus,the aorta or around the primary sinus were found in 48 cases(0.029%),531 cases(0.322%),respectively.Coronary artery originating from pulmonary artery was detected in 20 cases(0.012%),all of which were left main trunk originating from pulmonary artery,showed tortuous dilation of coronary arteries.Five cases showed obvious subendocardial myocardial ischemia or infarction without CAD.SCA,right coronary artery and conus branch arising separately,left anterior descending branch and circumflex artery arising separately were detected in 102(0.062%),53(0.032%)and 143(0.087%)cases respectively.Only 1 of 102 cases with SCA showed myocardial ischemia without CAD.A total of 548 cases(0.332%)were diagnosed as CAF,of which the coronary-pulmonary fistula was most common with a highest prevalence of 0.277%(458 cases).Coronary artery-atrial fistula and coronary artery-ventricular fistula were detected in 22(0.013%)and 60(0.036%)cases.There were 6 cases(0.004%)of coronary artery-coronary venous fistula and 2 cases(0.001%)of coronary artery-superior vena cava fistula.Conclusions The occurrence of CCAA is not uncommon,among which anomalous origin of coronary artery is the most common,and special attention should be paid to"malignant"anomalies.