Congenital anomalies of the coronary arteries
Congenital anomalies of the coronary arteries
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DOI：
10.1136/hrt.2004.057299
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发表时间：
2005-09-01
期刊：
影响因子：
5.7
通讯作者：
Hauser, M
中科院分区：
文献类型：
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作者：
Hauser, M
正常冠状动脉解剖的特点是两个开口位于Valsalva左右窦中央。左冠状动脉主干(LCA)起始于左冠状动脉口，分支至左前降支和回旋动脉，绕左房室沟；右冠状动脉(RCA)起自右冠状动脉口，提供漏斗内分支至心脏前侧，然后在房室沟向后走行。三支主要冠状动脉上至心房，下至心室，末端呈扫帚状的树枝状分支，穿透心肌。1由于心室收缩，左室心肌灌注主要发生在舒张期，而右室心肌在两个心动周期都有心肌灌注。2-4临床怀疑患者的问题可能是冠状动脉异常的结果仍然是诊断的一个重要挑战，特别是在儿童中。血流动力学显着的先天性冠状动脉异常以孤立或原发形式出现，也可作为继发性形式与先天性心脏病(先天性心脏病)(肺闭锁伴完整的室间隔或左心发育不良综合征伴主动脉闭锁和严重的二尖瓣狭窄)相关(表1)。在本文中，将只讨论孤立/主要形式。
Normal coronary artery anatomy is characterised by two ostia centrally placed in the right and left sinus of Valsalva. The main left coronary artery (LCA) originates from the left ostium, branching into the left anterior descending artery and circumflex artery, which courses around the left atrioventricular groove; the right coronary artery (RCA) arises from the right ostium, providing an infundibular branch to the anterior side of the heart, and then courses backward in the atrioventricular groove. The three main coronary arteries branch superiorly to the atria and inferiorly to the ventricles; they end in broom-like arborisations, which penetrate the myocardium. 1 Because of ventricular contraction myocardial perfusion of the left ventricle occurs mainly in diastole, while the myocardium of the right ventricle is perfused during both heart cycles. 2–4Clinical suspicion that a patient’s problems may be the result of coronary anomalies remains an important challenge in diagnosis, especially in children. Haemodynamically significant congenital anomalies of coronary arteries occur as isolated or primary forms and as secondary forms in association with congenital heart disease (CHD)(pulmonary atresia with intact interventricular septum or hypoplastic left heart syndrome with aortic atresia and severe mitral stenosis)(table 1). In this article only isolated/primary forms will be discussed.