Anomalous origin of the right coronary artery from the left coronary sinus with an intramural course: comparison between sudden-death and non-sudden-death cases
Anomalous origin of the right coronary artery from the left coronary sinus with an intramural course: comparison between sudden-death and non-sudden-death cases
复制标题
DOI：
10.1016/j.carpath.2014.11.004
复制
发表时间：
2015-05-01
影响因子：
3.7
通讯作者：
Nishida, Naoki
中科院分区：
文献类型：
--
作者：
Hata, Yukiko;Kinoshita, Koshi;Nishida, Naoki
背景：右冠状动脉(RCA)起源于左冠状静脉窦(LCS)的患者预后不一。在冠状动脉异常的病例中，最初的冠状动脉壁内过程被认为是导致心肌缺血的原因。方法：对5例RCA起源于LCS并有壁内过程的尸检病例的临床病理结果进行了分析。结果：5例中2例为心源性猝死，3例为非心源性死亡。在一个突然死亡的案例中，这个人在轻微的运动中晕倒了，在另一个案例中，这个人受到了冰毒的影响。两例猝死患者的冠状动脉分布均以RCA占优势，动脉粥样硬化性狭窄，房室传导系统周围的后基底室间隔出现急性缺血性坏死。结论：主动脉中膜内过程可能是起源于LCS的RCA因受压后血流减少的加速因素。然而，这一发现可能不是病理性缺血的独立预测因子。可能需要其他因素来减少室壁间段的血流量，以引起明显的心肌缺血。此外，可以升高血压的刺激因素也可能通过启动从主动脉到右冠状动脉壁内段的机械压迫而在引起症状性心肌缺血中发挥作用。(C)2014 Elsevier Inc.保留所有权利。
Background: The prognosis of patients in whom the right coronary artery (RCA) arises from the left coronary sinus (LCS) is unequal. An initial intramural course of the coronary artery within the aortic media is considered to cause myocardial ischemia in cases of coronary anomalies.Methods: Clinicopathological findings in five autopsy cases where the RCA arose from the LCS with an intramural course were examined. Comparison between sudden cardiac death and noncardiac death was also performed.Results: Two of five cases were sudden cardiac death, and the other three cases were noncardiac death. In one case of sudden death, the person collapsed during light exercise, and in the other case, the person was under the effect of methamphetamine. Both of the cases of sudden death showed an RCA-dominant pattern in distribution of the coronary artery, atherosclerotic narrowing of the RCA, and acute ischemic necrosis in the posterior basilar ventricular septum around the atrioventricular conduction system, which is considered to be the territory of the RCA.Conclusions: An intramural course within the aortic media may be an accelerating factor of decreased blood flow in cases with an origin of the RCA arising from the LCS because of compression from the aortic lumen. However, this finding may not be an independent predictor of pathological ischemia. Additional factors that diminish blood flow in the intramural segment may be required to cause significant myocardial ischemia. Additionally, inciting factors, which can increase blood pressure, may also play a role in causing symptomatic myocardial ischemia by initiating mechanical compression from the aorta to the intramural segment of the RCA. (C) 2014 Elsevier Inc. All rights reserved.