左主干起源于右冠状动脉窦(附2例报告并文献复习)

Anomalous Left Coronary Artery Arising From Right Sinus of Valsalva Two Cases Report and Review of the Literature

目的:分析左主干起源于右冠状动脉窦的临床特征,提高对左主干起源于右冠状动脉窦的认识和诊断。方法:回顾分析2例左主干起源于右冠状动脉窦的临床病例并对文献进行回顾分析。结果:左主干起源于右冠状动脉窦是一种罕见的先天性冠脉畸形,这种畸形可分为良性或恶性,主要根据异常左冠状动脉与主动脉和肺动脉之间的关系。对于可能引起猝死或严重心肌缺血患者,应进行冠状动脉旁路移植术。2例患者左主干起源于右冠状动脉窦,其中1例左主干走行于主动脉与肺动脉之间,1例走行于主动脉前方,这2例未进行预防性外科手术,目前预后良好。结论:左主干起源于右冠状动脉窦是罕见的冠脉畸形,应注意鉴别是良性或是恶性,确定下一步治疗方案。

Objectives: To analyze the clinical manifestations of origin of the left coronary artery from the right sinus of Valsava,and to improve its understanding and diagnosis.Methods:Retrospective analysis of two cases of the origin of the left coronary artery from the right sinus of Valsava and review of the literature.Results:The left coronary artery arising from the right sinus of Valsava is a rare congenital coronary anomaly. This anomaly is classified into benign and serious,depending on the relation of the anomalous left main artery to the aorta and pulmonary artery.The patients of the left coronary artery arsing from the right sinus of Valsava with high risk of sudden death or severe myocardial ischemia should be warrant prophylactic coronary bypass surgery.Two rare cases of anomalous left main artery arising from the right sinus of Valsava are reported,one case with a course between the aorta and pulmonary artery ,and the other case with a anterior course Both these two cases had not any evidence of myocardial ischemia, and prophylactic surgery were not performed .These two patients had good prognosis without cardiac events.Conclusion:The origin of the left coroanry artery from the right sinus of Valsava is a rare coronary artery anomaly, and it should not be tranditionally recommendede coronary bypass surgery in patients without any evidence to suggest myocardial ischemia.