Anomalous origin of left coronary artery from the pulmonary artery （ALCAPA） is a rare congenitalcardiac malformation. Here we report a case of ALCAPA with atrial septal defect （ASD） initially visualized by transth...Anomalous origin of left coronary artery from the pulmonary artery （ALCAPA） is a rare congenitalcardiac malformation. Here we report a case of ALCAPA with atrial septal defect （ASD） initially visualized by transthoracic echocardiography, subsequently confirmed by the coronary angiography.展开更多
目的分析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)行左冠状动脉移植术后的疗效及中期随访结果,并探讨是否需要同期处理反流的二尖瓣。方法 2005年3月至2015年3月...目的分析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)行左冠状动脉移植术后的疗效及中期随访结果,并探讨是否需要同期处理反流的二尖瓣。方法 2005年3月至2015年3月广东省心血管病研究所心外科共52例ALCAPA患者行左冠状动脉移植术,其中男20例、女32例,中位年龄10(2~193)个月,平均体质量(9.7±7.8)kg。按同期有无行二尖瓣成形术分为二尖瓣成形组(MVP组)及非二尖瓣成形组(Non-MVP组)。其中Non-MVP组35例,男14例、女21例,年龄(35.4±42.8)个月;MVP组17例,男6例、女11例,年龄(13.5±11.0)个月。为便于量化统计,二尖瓣反流按无、局限性、轻度、轻-中度、中度、中-重度及重度分别定义为0.0、1.0、2.0、2.5、3.0、3.5、4.0。结果术后左室短轴缩短率(LVFS)及左室舒张期末内径(LVEDD)均较术前明显改善[32.1%±10.1%vs.28.6%±9.6%,P=0.023;(30.5±5.7)mm vs.(38.4±5.6)mm,P<0.001],术后二尖瓣反流程度亦较术前明显减轻(2.4±1.2 vs.2.9±1.2,P=0.001)。术后早期死亡4例,死亡率7.7%(4/52)。中位随访时间21.0(1.5~111.0)个月,3例(5.8%)失访,1例(1.9%)接受再次手术,随访期间无死亡。末次随访LVFS较术后明显改善(38.0%±6.0%vs.32.1%±10.1%,P=0.001);末次随访二尖瓣反流程度与术后差异无统计学意义(2.3±1.2 vs.2.4±1.2,P=0.541),但有减轻趋势。两组体外循环时间、主动脉阻断时间、机械通气时间及住院时间差异并无统计学意义。结论采用左冠状动脉移植术恢复双冠状动脉供血,可显著改善ALCAPA患者左心室功能,是否需要同期处理反流的二尖瓣仍然存在争议。对于ALCAPA合并中-重度及重度二尖瓣反流的患者,同期行二尖瓣成形术有助于二尖瓣功能的早期恢复。展开更多
Background At present, creation of a dual coronary system with direct aortic implantation is the preferred management for anomalous origin of left coronary artery from the pulmonary artery （ALCAPA）. However, controv...Background At present, creation of a dual coronary system with direct aortic implantation is the preferred management for anomalous origin of left coronary artery from the pulmonary artery （ALCAPA）. However, controversy still exists over the initial management of mitral regurgitation （MR） at the time of ALCAPA repair. Methods Between March 2005 and March 2015, 52 consecutive patients （20 males and 32 females） underwent direct aortic implantation of ALCAPA. Median age at surgery was 10 months （range, 2 to 193）. Mean weight was 9.7_＋7.8 kg. In order to facilitate the analysis, description of MR was given a numeric grade： 0 = none, 1 = trivial, 2 = mild, 2.5 = mild-moderate, 3 = moderate, 3.5 = moderate-severe, and 4 = severe. Results The LV shortening fraction （LVFS） demonstrated significant improvement between presentation and discharge （32.1±10.1% vs. 28.6±9.6%, P = 0.023）, and there was also significant improvement in the mean MR grade between presentation and discharge （2.40＋1.16 vs. 2.91＋ 1.19, P = 0.001）. There were 4 hospital deaths （7.7%）. The median follow-up was 21 months （range 1.5 to 111）, 3 patients （5.8%） were lost to follow-up, 1 patient required reoperation for mitral valve replacement. Significant improvement was seen in LVFS between discharge and late follow-up （38.0±6.0% vs. 32.1±10.1%, P = 0.001）, however, the degree of MR did not dem- onstrate further change （2.29_＋1.20 vs. 2.40＋1.16, P = 0.541）. Conclusion Creation of a dual coronary system with direct aortic implantation of the left coronary artery results in complete recovery of left ventricular function. Concomitant mitral valve （MV） repair for ALCAPA patients with moderate-severe and severe MR is helpful to early MV function recovery.展开更多
A 55-year-old female known case of essential hypertension and diabetes was brought to the Emergency Department in a drowsy state with cardiogenic shock. At presentation systolic BP was 70 mm Hg, pulse rate was 44/min ...A 55-year-old female known case of essential hypertension and diabetes was brought to the Emergency Department in a drowsy state with cardiogenic shock. At presentation systolic BP was 70 mm Hg, pulse rate was 44/min and random blood sugar was 239 mg/dl. Troponin I was 8.07. Electrocardiography showed junctional rhythm and bradycardia. Ejection Fraction (LVEF) was 15% - 20%. Coronary angiography was done which revealed single vessel disease in LAD with anomalous origin of RCA from midsegment of LAD. Patient was immediately taken up for Off</span></span><span style="white-space:normal;"><span style="font-family:"">-</span></span><span style="white-space:normal;"><span style="font-family:"">pump Coronary Artery Bypass Grafting (OPCAB). Right saphenous vein graft was harvested and anastomosed proximally to aorta and distally to LAD on beating heart using Medtronic Octopus heart stabilizer and coronary shunts. Wound closed in layers after achieving complete hemostasis. Patient was taken off ventilatory support on first post-operative day and discharged in a stable condition on fourth post-operative day. Post-operative Echocardiography showed LVEF increased from 15% - 20% at time of admission to 38% and 52% after 3</span></span><span style="white-space:normal;"><span style="font-family:""> </span></span><span style="white-space:normal;"><span style="font-family:"">months and 12 months of surgery respectively.展开更多
目的:探讨冠状动脉起源于对侧乏氏窦(Anomalous aortic origin of coronaries from the contralateral sinus,AAOCA)且冠状动脉走行异常的超声表现,改良超声心动图检查切面,提高检出率。方法:回顾我院2例动脉干间走行AAOCA患者超声心动...目的:探讨冠状动脉起源于对侧乏氏窦(Anomalous aortic origin of coronaries from the contralateral sinus,AAOCA)且冠状动脉走行异常的超声表现,改良超声心动图检查切面,提高检出率。方法:回顾我院2例动脉干间走行AAOCA患者超声心动图表现,并查阅相关文献,总结AAOCA患者的超声心动图漏误诊经验。结果:1.病例一左侧乏氏窦(left Valsava sinus,LVS)未探及左冠状动脉(left coronary artery,LCA)开口,LCA起源于右侧乏氏窦(right Valsava sinus,RVS),并LCA主干立即成角移行走行于主动脉与肺动脉主干之间;彩色多普勒可观察到LCA主干干间走行段血流信号经多排螺旋CT证实。2.病例二为RVS未探及确切冠状动脉开口,右侧冠状动脉(right coronary artery,RCA)异常起源于LVS,并RCA主干立即成角移行走行于主动脉与肺动脉主干之间;彩色多普勒可观察到RCA干间走行段血流信号。结论:一侧冠状动脉异常起源对侧冠状窦超声心动图检查容易漏诊,改良超声心动图检查切面可提高检出率,有利于降低患者心源性猝死风险。展开更多
文摘Anomalous origin of left coronary artery from the pulmonary artery （ALCAPA） is a rare congenitalcardiac malformation. Here we report a case of ALCAPA with atrial septal defect （ASD） initially visualized by transthoracic echocardiography, subsequently confirmed by the coronary angiography.
文摘目的分析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)行左冠状动脉移植术后的疗效及中期随访结果,并探讨是否需要同期处理反流的二尖瓣。方法 2005年3月至2015年3月广东省心血管病研究所心外科共52例ALCAPA患者行左冠状动脉移植术,其中男20例、女32例,中位年龄10(2~193)个月,平均体质量(9.7±7.8)kg。按同期有无行二尖瓣成形术分为二尖瓣成形组(MVP组)及非二尖瓣成形组(Non-MVP组)。其中Non-MVP组35例,男14例、女21例,年龄(35.4±42.8)个月;MVP组17例,男6例、女11例,年龄(13.5±11.0)个月。为便于量化统计,二尖瓣反流按无、局限性、轻度、轻-中度、中度、中-重度及重度分别定义为0.0、1.0、2.0、2.5、3.0、3.5、4.0。结果术后左室短轴缩短率(LVFS)及左室舒张期末内径(LVEDD)均较术前明显改善[32.1%±10.1%vs.28.6%±9.6%,P=0.023;(30.5±5.7)mm vs.(38.4±5.6)mm,P<0.001],术后二尖瓣反流程度亦较术前明显减轻(2.4±1.2 vs.2.9±1.2,P=0.001)。术后早期死亡4例,死亡率7.7%(4/52)。中位随访时间21.0(1.5~111.0)个月,3例(5.8%)失访,1例(1.9%)接受再次手术,随访期间无死亡。末次随访LVFS较术后明显改善(38.0%±6.0%vs.32.1%±10.1%,P=0.001);末次随访二尖瓣反流程度与术后差异无统计学意义(2.3±1.2 vs.2.4±1.2,P=0.541),但有减轻趋势。两组体外循环时间、主动脉阻断时间、机械通气时间及住院时间差异并无统计学意义。结论采用左冠状动脉移植术恢复双冠状动脉供血,可显著改善ALCAPA患者左心室功能,是否需要同期处理反流的二尖瓣仍然存在争议。对于ALCAPA合并中-重度及重度二尖瓣反流的患者,同期行二尖瓣成形术有助于二尖瓣功能的早期恢复。
基金supported by Guangdong Province Medical Scientific Research Foundation(No.A2016116)
文摘Background At present, creation of a dual coronary system with direct aortic implantation is the preferred management for anomalous origin of left coronary artery from the pulmonary artery （ALCAPA）. However, controversy still exists over the initial management of mitral regurgitation （MR） at the time of ALCAPA repair. Methods Between March 2005 and March 2015, 52 consecutive patients （20 males and 32 females） underwent direct aortic implantation of ALCAPA. Median age at surgery was 10 months （range, 2 to 193）. Mean weight was 9.7_＋7.8 kg. In order to facilitate the analysis, description of MR was given a numeric grade： 0 = none, 1 = trivial, 2 = mild, 2.5 = mild-moderate, 3 = moderate, 3.5 = moderate-severe, and 4 = severe. Results The LV shortening fraction （LVFS） demonstrated significant improvement between presentation and discharge （32.1±10.1% vs. 28.6±9.6%, P = 0.023）, and there was also significant improvement in the mean MR grade between presentation and discharge （2.40＋1.16 vs. 2.91＋ 1.19, P = 0.001）. There were 4 hospital deaths （7.7%）. The median follow-up was 21 months （range 1.5 to 111）, 3 patients （5.8%） were lost to follow-up, 1 patient required reoperation for mitral valve replacement. Significant improvement was seen in LVFS between discharge and late follow-up （38.0±6.0% vs. 32.1±10.1%, P = 0.001）, however, the degree of MR did not dem- onstrate further change （2.29_＋1.20 vs. 2.40＋1.16, P = 0.541）. Conclusion Creation of a dual coronary system with direct aortic implantation of the left coronary artery results in complete recovery of left ventricular function. Concomitant mitral valve （MV） repair for ALCAPA patients with moderate-severe and severe MR is helpful to early MV function recovery.
文摘A 55-year-old female known case of essential hypertension and diabetes was brought to the Emergency Department in a drowsy state with cardiogenic shock. At presentation systolic BP was 70 mm Hg, pulse rate was 44/min and random blood sugar was 239 mg/dl. Troponin I was 8.07. Electrocardiography showed junctional rhythm and bradycardia. Ejection Fraction (LVEF) was 15% - 20%. Coronary angiography was done which revealed single vessel disease in LAD with anomalous origin of RCA from midsegment of LAD. Patient was immediately taken up for Off</span></span><span style="white-space:normal;"><span style="font-family:"">-</span></span><span style="white-space:normal;"><span style="font-family:"">pump Coronary Artery Bypass Grafting (OPCAB). Right saphenous vein graft was harvested and anastomosed proximally to aorta and distally to LAD on beating heart using Medtronic Octopus heart stabilizer and coronary shunts. Wound closed in layers after achieving complete hemostasis. Patient was taken off ventilatory support on first post-operative day and discharged in a stable condition on fourth post-operative day. Post-operative Echocardiography showed LVEF increased from 15% - 20% at time of admission to 38% and 52% after 3</span></span><span style="white-space:normal;"><span style="font-family:""> </span></span><span style="white-space:normal;"><span style="font-family:"">months and 12 months of surgery respectively.
