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中华临床医师杂志(电子版) ›› 2024, Vol. 18 ›› Issue (06) : 596 -599. doi: 10.3877/cma.j.issn.1674-0785.2024.06.013

病例报告

单纯结扎术治疗左冠状动脉异常起源于肺动脉疗效观察
何良勇1,(), 童健2, 张福伟2, 丁明明3   
  1. 1. 528437 广东 中山,中山火炬开发区人民医院胸外科
    2. 510280 广州,南方医科大学珠江医院胸外科
    3. 528437 广东 中山,中山火炬开发区人民医院呼吸与危重症医学科
  • 收稿日期:2024-02-20 出版日期:2024-06-15
  • 通信作者: 何良勇

Efficacy of simple ligation of the left coronary artery in treating anomalous origin of the left coronary artery from the pulmonary artery: report of two cases

Liangyong He(), Jian Tong, Fuwei Zhang   

  • Received:2024-02-20 Published:2024-06-15
  • Corresponding author: Liangyong He
引用本文:

何良勇, 童健, 张福伟, 丁明明. 单纯结扎术治疗左冠状动脉异常起源于肺动脉疗效观察[J]. 中华临床医师杂志(电子版), 2024, 18(06): 596-599.

Liangyong He, Jian Tong, Fuwei Zhang. Efficacy of simple ligation of the left coronary artery in treating anomalous origin of the left coronary artery from the pulmonary artery: report of two cases[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(06): 596-599.

左冠状动脉异常起源于肺动脉(anomalous origin of the left coronary artery from the pulmonary artery,ALCAPA)是一种罕见又极具生命威胁的先天性冠状动脉畸形。发病率极低,每30万活婴中仅有1例,在先天性心脏病中所占比例约为0.24%至0.46%。未行手术治疗的患儿在1岁内死亡率高达90%,若存在丰富的侧支循环,则可过渡至成人型,由于合并冠状动脉-肺动脉窃血所致的心肌缺血,大多数成年患者可在平均年龄35岁时发生猝死。近年来,随着心动超声图、心导管检查和增强CT等检查技术的提高,并给予早期的手术治疗,使ALCAPA的诊断率和预后得到了极大的改善。

图1 病例1影像检查及手术所见图。图a为术前心脏彩超提示右冠状动脉开口于肺动脉;图b为术前心导管造影检查,右冠状动脉明显增粗、迂曲、分支粗大,左冠状动脉显影较迟,正位观察不清;图c为病例1术中照片,见LCA异位起源于PA根部前壁,RCA明显迂曲、增粗,左、右冠状动脉间有较丰富的交通支 注:LCA为左冠状动脉;PA为主肺动脉;RCA为右冠状动脉
图2 病例2影像检查及手术所见图。图a为病例2术前心脏彩超见LCA异常起源于肺动脉;图b为增强CT重建直接观察ALCAPA;图c为病例2术中所见,RCA主干直径约1.5 cm,迂曲膨大,LCA主干开口于主肺动脉后壁,直径约0.5 cm,左右冠状动脉之间有大量交通支 注:LCA为左冠状动脉;RCA为右冠状动脉;LCA为左冠状动脉
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