【摘要】 冠脉发育畸形在行经皮冠脉血管成形术患者中约占1.3%,大多为偶然发现,并无较多临床意义。但走行与主动脉、肺动脉间的冠状动脉发育畸形可引起晕厥、心绞痛、心律失常及心性猝死。左、右冠状动脉共干鲜有文献报道,发生率约为人群的0.024-0.044%。左冠状动脉发自右冠并分出前降支(LAD)及回旋支(LCX),是一种少见的冠状动脉发育畸形。此种发育畸形患者前降支往往发育细小,右冠状动脉发育粗大、优势。本文报道1例罹患此种畸形同时合并亚急性心肌梗死病例,冠脉造影及CT血管成像证实左冠状动脉发自右冠状动脉近端,左主干长,走行于左室前壁后分为LAD及LCX,其LAD发育小并走行于前室间沟,RCA发育优势,供应左室下、后壁及部分侧壁。虽然该患者成功进行择期经皮冠状动脉介入治疗并于其RCA近端置入药物支架,但此种病例应视为左主干病变,介入操作治疗中应谨慎、细心。更多还原

【Abstract】 Objective Although the majority of coronary artery anomalies are found incidentally and not clinically significant,the interarterial course between the major vessels of the aberrant artery may be responsible for syncope,angina,arrhythmias or sudden death.There are only a few case reports describing the origination of all the coronary arteries from a single ostium.This anomaly occurs in only 0.024%-0.044% of the population.Left coronary artery originating from the right coronary is a rare coronary abnormality.Here we report a case of acute myocardial infarction in a patient with anomalous left coronary artery originating from the right coronary artery,as was confirmed by computerized tomography angiogram,which showed that only one single coronary artery stem originating from the right sinus of Valsalva trifurcated into a right coronary artery,left circumflex artery and a hypoplastic left anterior descending artery.Subsequent percutaneous coronary intervention(PCI) procedures were performed successfully.PCI procedures should be carried out with great caution in such cases,and this condition should be managed as a left main lesion.更多还原