Left main coronary artery atresia: Literature review and therapeutical considerations
Left main coronary artery atresia: Literature review and therapeutical considerations
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DOI：
10.1016/s1010-7940(96)01121-9
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发表时间：
1997-03-01
影响因子：
3.4
通讯作者：
DeGasperis, C
中科院分区：
文献类型：
--
作者：
Musiani, A;Cernigliaro, C;DeGasperis, C
目的：左冠状动脉主干闭锁是一种罕见的冠状动脉异常，其中没有左冠状动脉口，左主干近端盲端，血液从右冠状动脉通过小侧支动脉流向左侧，并在至少一条左侧动脉中逆行。由于已发表的病例报告很少且相当分散，因此无法获得有关这种罕见异常的全面信息。方法：通过电子（MEDLINE和INTERNET）和手动扫描在主要医学期刊中全面检索已发表的左主干冠状动脉闭锁病例。结果如下：作者发现了28例左主干闭锁（包括2例来自他们自己的经验），其中15例为儿童;其中5例伴有心脏异常。儿童患者通常在生命早期出现明显症状（晕厥、呼吸困难、猝死、发育不全、梗死、室性心动过速），而成人患者仅在高龄时才开始出现症状（心绞痛、呼吸困难、猝死）;但相关冠状动脉粥样硬化似乎不常见（2/13例成人患者：15%）。我们只知道一个无症状的病人，一位76岁的老太太死于无关的原因，在她的情况下，左主干闭锁是一个不可预见的尸检结果。4名未经治疗的患者突然死亡;其他大多数患者症状严重，需要手术治疗，通常是通过一个或多个隐静脉或乳房动脉移植物直接进行冠状动脉血运重建至左侧动脉;据报告，所有血运重建患者均存活且状况良好;在1例儿科病例中，使用主动脉壁挡板重建了左主干冠状动脉，结果良好。相比之下，未接受血运重建的患者的结局较差。结论：鉴于手术治疗的良好效果，作者赞同对所有左冠状动脉主干闭锁患者进行及时的冠状动脉血运重建。(C)1997年Elsevier Science B.V.
Objective: Left main coronary artery atresia is a rare coronary anomaly in which there is no left coronary ostium, the proximal left main trunk ends blindly, blood flows from the right coronary artery to the left via small collateral arteries and retrogradely in at least one of the left-sided arteries. Since published case reports are few and rather scattered, no comprehensive information about this uncommon anomaly is available. Methods: A thorough search for published cases of left main coronary atresia was performed in the major medical journals by electronic (MEDLINE and INTERNET) and hand-scanning. Results: The authors found 28 cases of left main atresia (including two from their own experience), 15 of which were pediatric; five of these cases had associated cardiac anomalies. While pediatric patients were usually overtly symptomatic early in their life (syncope, dyspnea, sudden death, failure to thrive, infarction, ventricular tachycardia), adult patients began showing symptoms (angina, dyspnea, sudden death) only at an advanced age; associated coronary atherosclerosis seemed to be uncommon, though (2/13 adult patients: 15%). We know of only one asymptomatic patient, a 76-year old lady who had died of unrelated causes; in her case left main atresia was an unforeseen autopsy finding. Four untreated patients had died suddenly; most of the others were highly symptomatic and required surgical therapy, usually as direct coronary artery revascularization via one or more saphenous vein or mammary artery grafts to the left-sided arteries; all revascularized patients were reported to be alive and well; in one pediatric case the left main coronary artery was reconstructed using an aortic wall baffle, with a good result. In contrast, the outcome of patients who did not receive revascularization has been poor. Conclusion: In light of the favorable results obtained by surgical therapy, the authors endorse prompt coronary artery revascularization for all patients with left main coronary artery atresia. (C) 1997 Elsevier Science B.V.