Recurrent sudden cardiac death secondary to anomalous right coronary artery: Insights into prevalence and management.
Recurrent sudden cardiac death secondary to anomalous right coronary artery: Insights into prevalence and management.
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DOI：
10.1177/2050313x221100878
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发表时间：
2022
影响因子：
0.8
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中科院分区：
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一名32岁的女性在室颤停搏后就诊，需要三次除颤。该事件与上呼吸道感染和体力消耗同时发生。八年前，她在分娩时因不明原因而心脏骤停。这一次，影像学显示异常的右冠状动脉连接到左冠状动脉尖，在主动脉和肺动脉之间有一个小的裂缝状骨开口。手术探查发现右冠状动脉壁内段，通过手术取出冠状动脉顶，心功能改善。植入心律转复除颤器用于心脏性猝死的二级预防。恶性异常冠状动脉推荐手术治疗，术后心律失常复发和心源性猝死的风险非常低。然而，随着越来越多的证据表明，即使在异常冠状动脉手术矫正后，心律失常和心源性猝死的风险仍然存在，更多的专家选择采取二级预防措施作为初始管理的一部分。
A 32-year-old woman presented after ventricular fibrillation arrest requiring three defibrillations. The episode coincided with an upper respiratory infection and physical exertion. Eight years prior, she survived another cardiac arrest of unknown cause during childbirth. This time, imaging revealed an anomalous right coronary artery connecting to the left coronary cusp, with a small, slit-like osteal orifice coursing between the aorta and pulmonary artery. Surgical exploration revealed an intramural segment of the right coronary artery, which was surgically unroofed with improvement in cardiac function. An implantable cardioverter-defibrillator was implanted for secondary prevention of sudden cardiac death. Surgery is recommended for malignant anomalous coronary arteries, with a very low risk of recurrence of arrhythmia and sudden cardiac death after surgery. However, with growing evidence for persistent risk of arrhythmia and sudden cardiac death even after surgical correction of the anomalous coronary arteries, more experts choose to take secondary prevention measures as a component of initial management.