不同类型冠状动脉异常起源于肺动脉成年患者手术矫治前后超声心动图特点

Echocardiographic Characteristics Before and After Operation in Adults With Different Types of Abnormal Origin of Coronary Artery From Pulmonary Artery

目的:探讨不同年龄、左心室射血分数(LVEF)、二尖瓣关闭不全程度冠状动脉异常起源于肺动脉(ACAPA)成年患者手术矫治前后超声心动图特点。方法:回顾性分析自2007年1月1日至2020年12月31日期间在首都医科大学附属北京安贞医院心脏内科和外科病房收治且明确诊断为单纯ACAPA的成年患者26例,并依据年龄分为≤20岁组(n=7)、>20~40岁组(n=8)与>40岁组(n=11);按照LVEF分为减低组(LVEF<50%,n=3)与正常组(LVEF≥50%,n=23例);按照二尖瓣关闭不全程度分为中重度二尖瓣关闭不全组(n=14)与轻度以下二尖瓣关闭不全组(n=12)。分析26例患者以及不同组别患者手术矫治前后超声心动图参数的变化。结果:26例患者中,左冠状动脉异常起源于肺动脉(ALCAPA)24例(92.3%),右冠状动脉异常起源于肺动脉(ARCAPA)2例(7.7%);平均年龄(36.0±16.8)岁,女性18例(69.2%)。超声心动图各参数与年龄均无相关性(P均>0.05)。与≤20岁组相比,室壁运动异常在>40岁组中更为常见(P<0.05)。LVEF减低组与正常组左心房前后径、左心室舒张末期内径、肺动脉内径、左冠状动脉开口内径、右冠状动脉开口内径、二尖瓣关闭不全、室壁运动异常的差异均无统计学意义(P均>0.05),不同二尖瓣关闭不全程度的两组上述参数相比结果类似。LVEF与右冠状动脉开口内径也无明显相关性(r=0.28,P=0.25)。22例患者行手术矫治治疗,平均随访(31.3±27.2)个月,7例失访。与术前相比,15例患者术后左心房前后径[(41.46±5.47)mm vs.(34.77±6.18)mm]、左心室舒张末期内径[(57.00±4.89)mm vs(.47.85±5.37)mm]及二尖瓣关闭不全程度均改善(P均<0.05)。结论:成年人ACAPA患者以女性为主,心脏结构改变与年龄变化无明显关系,>40岁的患者出现左心室壁运动异常更常见,术后部分血液动力学参数改善。

Objectives:To investigate the clinical manifestation of adult patients with abnormal origin of coronary artery from pulmonary artery(ACAPA)and the correlation between patient age and cardiac structure,as well as the changes in cardiac structure with varying degrees of left heart function and mitral insufficiency,as well as the characteristics of the cardiac structure and hemodynamic before and after surgery.Methods:This retrospective analysis included 26 patients admitted to the department of cardiology and surgical ward of Beijing Anzhen Hospital from January 1,2007 to December 31,2020,who were diagnosed as ACAPA.The clinical and surgical data,symptoms and imaging results of all patients were analyzed.Grouping of patients:(1)group≤20 years old(n=7);over 20 years old,and under 40 years old(n=8);over 40 years old(n=11);(2)reduced left ventricular ejection fraction(LVEF)group(LVEF<50%)(n=3)and normal LVEF group(LVEF≥50%)(n=23);(3)the moderate to severe mitral insufficiency group(n=14)and mild to mild mitral insufficiency group(n=12).Echocardiographic parameters of different groups and before and after surgical correction were compared.Results:Among the 26 cases,24 cases(92.3%)had anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA),and 2 cases(7.7%)had anomalous origin of the right coronary artery from the pulmonary artery(ARCAPA);the average age was(36.0±16.8)years old,with 18 females(69.2%).Compared with the≤20 year old group,abnormal wall motion was more common in the>40 year old group,and there was no correlation between other echocardiographic parameters and age(P>0.05).There was no statistically significant difference in the left atrial anteroposterior diameter,left ventricular end diastolic diameter,pulmonary artery diameter,left coronary artery opening diameter,right coronary artery opening diameter,mitral insufficiency,and abnormal wall motion between the LVEF reduced group and the LVEF normal group(all P>0.05).The results were similar between the two groups with different degrees of mitral insufficiency.There was no significant correlation between LVEF and the diameter of the right coronary artery opening(r=0.28,P=0.25).22 cases underwent surgical correction treatment,with an average follow-up of(31.3±27.2)months,and 7 cases were lost to follow up.The left atrial anteroposterior diameter([34.77±6.18]mm vs.[41.46±5.47]mm),left ventricular end diastolic diameter([47.85±5.37]mm vs.[57.00±4.89]mm),and degree of mitral insufficiency improved in 15 cases after surgery(all P<0.05).Conclusions:The majority of ACAPA patients are female in this cohort,and there is no significant association between cardiac structure changes and age.Abnormal left ventricular wall movement is more common in patients over 40 years old,and some hemodynamic parameters are improved after surgery.