青少年冠状动脉异位起源于对侧冠状动脉窦的经胸超声心动图诊断

doi:10.3969/j.issn.1673-5501.2021.02.010

摘要/Abstract

摘要： 背景冠状动脉异位起源于对侧冠状动脉窦(ACAOS)是非常罕见的冠状动脉畸形,如果在青少年时期发病常会引起非常严重的后果,例如心绞痛、心肌梗死甚至心源性猝死 (SCD),诊断ACAOS主要的影像学检查方法包括心脏多层螺旋 CT(MDCT)及冠状动脉造影(CAG),而通过经胸超声心动图(TTE)诊断ACAOS的报道较少。目的探讨青少年时期发病的ACAOS患儿的超声心动图表现及扫查时的注意事项,提高对本病的认识及TTE的诊断准确率。设计通过回顾分析经多种检查手段或手术确诊的青少年时期发病的ACAOS患者的TTE检查结果,总结其超声心动图特点及扫查要点。方法选择2016年4月至2019年9月期间北京安贞医院小儿心脏中心收治的9例ACAOS患儿,所有患儿均经多种影像学检查和/或外科手术证实。主要结局指标 ACAOS的TTE表现。结果 9例ACAOS 患儿中,6例ALCAOS,3例ARCAOS,所有患儿在剧烈运动后均出现相关的临床症状,表现为胸闷、胸痛、晕厥甚至猝死;9例患者中,7例行外科手术,2例定期门诊复查。TTE表现:① 冠状动脉异位起源位置稍高,左侧胸骨旁高位大动脉短轴切面可清楚显示异位的冠状动脉开口;② 冠状动脉壁内走行时冠状动脉入口和出口位置不一致;③ 存在冠状动脉壁内走行的主动脉壁呈"双层征";④ 彩色多普勒(CDFI)可显示走行于主动脉与肺动脉根部之间的冠状动脉及壁内走行冠状动脉呈线性的舒张期血流信号;⑤ 频谱多普勒可测量冠状动脉内异常血流的速度,同时还可判断异常血流的时相。结论 TTE是首选的筛查及诊断ACAOS的影像学手段,在诊断过程中要密切结合患者的临床表现,特别是对运动后出现胸闷、胸痛、晕厥及猝死的青少年人群,TTE对提高ACAOS的检出率至关重要。

关键词: 冠状动脉异位起源于对侧冠状动脉窦, 经胸超声心动图, 心源性猝死, 冠状动脉壁内走行

Abstract: Backgrounds Anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS) is a very rare coronary artery malformation. If it occurs during adolescence, it will cause very serious consequences, such as angina pectoris, myocardial infarction and even sudden cardiac death (SCD). The main imaging examination methods for the diagnosis of ACAOS include multi-detector row computed tomographic (MDCT) and coronary angiography (CAG). However, transthoracic echocardiography (TTE) has rarely been reported in the diagnosis of ACAOS.Objective To explore echocardiographic characters of adolescent ACAOS patients and announcements for scanning, and to improve the understanding for this disease, the detection rate and the diagnostic accuracy of TTE.DesignBy retrospectively analyzing the results of TTE in adolescent ACAOS patients diagnosed by multiple examination methods or surgery, the echocardiographic features and scanning points were summarized.Methods Between April 2016 and September 2019, 9 hospitalized patients with ACAOS were retrospectively reviewed at the Pediatric Cardiovascular Center, Beijing Anzhen Hospital. All patients were confirmed by multiple imagings and/or surgical procedures.Main Outcome MeasuresThe echocardiographic characters of ACAOS.Results Among 9 patients with ACAOS, 6 patients were ALCAOS and 3 patients were ARCAOS. All patients had related clinical symptoms after strenuous exercise, including chest congestion, chest pain, syncope and even sudden death. Seven patients underwent surgical operations and 2 patients underwent regular outpatient reexamination.The echocardiographic characters of ACAOS include a.The origin of ectopic coronary artery was slightly higher than the normal origin, and the origin of ectopic coronary artery could be clearly shown in the left high parasternal short axis view. b.The inlet and outlet of coronary artery was not consistent for intramural coronary artery. c.The wall of the aorta with intramural coronary artery was displayed as a "double-border". d.Color Doppler flow imaging could display the linear diastolic blood flow signals of the coronary artery and intramural coronary artery running between the aorta and the root of the pulmonary artery. e.Spectral Doppler could measure the velocity of abnormal blood flow in coronary artery and determine the time phase of abnormal blood flow.Conclusion TTE is the preferred imaging method for screening and diagnosis of ACAOS. In the diagnosis process, the clinical manifestations of patients should be closely combined, especially for adolescents who have chest congestion, chest pain, syncope and sudden death after exercise. TTE is crucial to improve the detection rate of this disease.

Key words: Anomalous origin of a coronary artery from the opposite sinus of Valsalva, Transthoracic echocardiography, Sudden cardiac death, Intramural coronary artery

李文秀, 王兆富, 耿斌, 杨爽, 吴江. 青少年冠状动脉异位起源于对侧冠状动脉窦的经胸超声心动图诊断[J]. 中国循证儿科杂志, 2021, 16(2): 130-135.

LI Wenxiu, WANG Zhaofu, GENG Bin, YANG Shuang, WU Jiang. The diagnosis of anomalous origin of a coronary artery from the opposite sinus of Valsalva in adolescents by transthoracic echocardiography[J]. Chinese Journal of Evidence-Based Pediatrics, 2021, 16(2): 130-135.

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