冠状动脉介入治疗罕见异常起源的左回旋支急性闭塞1例

One case of coronary intervention treatment for acute occlusion of the left circumfl ex artery with rare abnormal origin

冠状动脉异常起源是心血管疾病中罕见的临床表现。其中,左回旋支的异常起源占全部冠状动脉造影患者的0.022%~0.024%。而左回旋支异常起源合并急性闭塞的病例则更为罕见。术中及时制订有效的寻找异常开口的策略和方法对完成介入治疗非常重要。本病例报道1例冠状动脉介入治疗罕见左回旋支异常起源于无冠窦且左回旋支急性闭塞导致心肌梗死。患者突发胸痛入院,心电图提示下壁、后壁ST段抬高。急行冠状动脉造影示仅见左主干及左前降支、右冠状动脉(心肌梗死溶栓治疗试验血流分级Ⅲ级),而未见左回旋支。左右冠窦内均未发现左回旋支。于升主动脉根部非选择造影,最后于无冠窦内发现开口异常的左回旋支。本病例针对异常起源左回旋支常见部位、寻找异常开口的策略、方法及介入治疗等方面进行讨论。

Abnormal origin of coronary artery is a rare clinical manifestation in cardiovascular disease,among which the abnormal origin of left circumflex artery accounts for 0.022%-0.024%of all coronary angiography patients.Cases of abnormal origin of the left circumfl ex artery combined with acute occlusion are even rarer.Timely and eff ective strategies and methods for fi nding abnormal openings during surgery are crucial for completing interventional treatment.This case reports a rare left circumfl ex artery anomaly originating from the absence of coronary sinus and acute occlusion of the left circumfl ex artery leading to myocardial infarction during coronary intervention treatment.The patient experienced sudden chest pain and was admitted to the hospital.The electrocardiogram showed elevated ST segments in the lower and posterior walls.The acute coronary angiography showed only the left main trunk,left anterior descending branch,and right coronary artery(thrombolysis in myocardial infarction blood fl ow gradeⅢ),but no left circumfl ex branch No left circumfl ex branch was found in the left and right coronary sinuses.Non selective angiography was performed at the root of the ascending aorta,and an abnormal opening of the left circumfl ex branch was fi nally discovered in the non coronal sinus.This case discusses common sites of abnormal origin of the left circumfl ex branch,strategies,methods,and interventional treatments for fi nding abnormal openings.