Two adult cases of congenital atresia of the left coronary ostium - comparison of a sudden death case with a long-term survival case
Two adult cases of congenital atresia of the left coronary ostium - comparison of a sudden death case with a long-term survival case
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DOI：
10.1007/s00428-005-0017-0
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发表时间：
2005-10-01
期刊：
影响因子：
3.5
通讯作者：
Yoshioka, N
中科院分区：
文献类型：
--
作者：
Nishida, N;Chiba, T;Yoshioka, N
我们提出两个极为罕见的尸检病例与闭锁的左冠状动脉口。病例1为34岁男性，死于突发心脏原因伴局限性急性内膜下梗死;病例2为82岁女性，死于非心脏原因。在这两种情况下，发现一个字符串样的小左主干，位于其正常的位置，但是，左冠状动脉的开口都没有在这两种情况下。侧支动脉（CA）起源于右冠状窦，与左前降支（LAD）远端吻合，其管径小于LAD近端管径。然而，只有在病例1中，CA才表现出从主动脉起飞的锐角，随后在主动脉根部和肺动脉干之间流动，可能受到这两条动脉的机械压迫。这两个病例表明，左冠状动脉口闭锁的发育和解剖不同于单冠状动脉或左冠状动脉起源于对侧主动脉窦。左冠状动脉口闭锁被认为是一个重要的鉴别诊断，作为猝死的原因，不仅在儿科人群，而且在成人。冠状动脉的口径和/或其他解剖特征可能主要决定左冠状动脉口闭锁患者的临床病程。
We present two extremely rare autopsy cases with atresia of the left coronary ostium. Case 1 was a 34-year-old man who died of sudden cardiac causes with localized acute subendocardial infarction and Case 2 was an 82-year-old woman who died from non-cardiac causes. In both cases, a string-like small left main trunk that was located in its normal position was found; however, the orifice of the left coronary artery was absent in both cases. The collateral artery (CA), whose caliber was smaller than that of the proximal left descending artery (LAD), arose from the right coronary sinus and was anastomosed with the distal LAD. However, it was only in Case 1 that the CA showed an acute angle of take-off from the aorta, subsequently coursing between the root of the aorta and the pulmonary trunk, with possible mechanical compression by these two arteries. These two cases suggest that atresia of the left coronary ostium is developmentally and anatomically different from single coronary artery or left coronary artery arising from the opposite sinus of valsalva. Atresia of the left coronary ostium is considered to be an important differential diagnosis as a cause of sudden death, not only in the pediatric population but also in adults. The caliber and/or other anatomical features of the CA may predominantly dictate the clinical course of patients with atresia of the left coronary ostium.