科研之友
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摘要
We here present the case of a rarely seen anomalous origin and retropulmonary course of the left circumflex artery from the proximal right coronary artery. The patient suffered from coronary ischemia due to stenotic lesions both in the aberrant circumflex coronary artery and in the first and second diagonal branches. Coronary bypass operation was performed. 1. Case Description A 66-year-old man with a history of sick-sinus-syndrome, mild arterial hypertension, hyperlipidemia, and carotid atheromatosis was admitted to our hospital with angina pectoris and dyspnea, occurring during exercise (NYHA III) since five months. Physical examination was unremarkable. The ECG showed sinus bradycardia without ST changes. Transthoracic echocardiography showed normal left ventricular systolic and diastolic function with sclerosis of the aortic valve, without insufficiency or stenosis and a low-grade mitral valve insufficiency. Evidence of myocardial ischemia was found when the patient developed ST changes during the treadmill exercise test. Coronary angiography was performed and revealed an anomalous origin of the left circumflex artery (LCx) from the right coronary sinus, in close proximity to the right coronary ostium. In addition, after following a retroaortic course, the LCx spiralled caudal of the pulmonary trunk to resurface in the left atrio-ventricular groove (Figures 1 and 2). The peripheral distribution of the LCx was normal. It showed a significant (90%) obstructive lesion during its course. In addition, second (90%) and third (60%) significant obstructions were detected in the first and second diagonal branches (diagonal (D) first (1), second (2)). Both the left anterior descending coronary artery and the right coronary artery (RCA) showed diffuse sclerosis and normal distribution. Surgical therapy was initiated and we performed a coronary bypass operation with a sequential venous bypass to the LCx and D1. Figure 1: Cardiac catheterization image (LAO) demonstrating the anomalous coronary system. LCx originates from right sinus of valsalva. Mind the retro-aortal route of the LCx (arrow depicts both spiralling course of LCx around the aorta and significant stenosis in LCx). Figure 2: Angio CT showing retro-aortal route of anomalous LCx. The postoperative course was uneventful and the patient was discharged 8 days later. 2. Discussion Coronary artery anomalies can be found in approximately 0.6% to 1.3% of all patients who are evaluated with coronary arteriography [1每5]. In the case of an anomalous origin of the LCx which is one of the most common anomalies
- 出版日期2010
