CAJ | 학술논문

冠脉发育畸形在行经皮冠脉血管成形术患者中约占1.3％,大多为偶然发现,并无较多临床意义.但走行与主动脉、肺动脉间的冠状动脉发育畸形可引起晕厥、心绞痛、心律失常及心性猝死.左、右冠状动脉共干鲜有文献报道,发生率约为人群的0.024-0.044％.左冠状动脉发自右冠并分出前降支(LAD)及回旋支(LCX),是一种少见的冠状动脉发育畸形.此种发育畸形患者前降支往往发育细小,右冠状动脉发育粗大、优势.本文报道1例罹患此种畸形同时合并亚急性心肌梗死病例,冠脉造影及CT血管成像证实左冠状动脉发自右冠状动脉近端,左主干长,走行于左室前壁后分为LAD及LCX,其LAD发育小并走行于前室间沟,RCA发育优势,供应左室下、后壁及部分侧壁.虽然该患者成功进行择期经皮冠状动脉介入治疗并于其RCA近端置入药物支架,但此种病例应视为左主干病变,介入操作治疗中应谨慎、细心.
관맥발육기형재행경피관맥혈관성형술환자중약점1.3％,대다위우연발현,병무교다림상의의.단주행여주동맥、폐동맥간적관상동맥발육기형가인기훈궐、심교통、심률실상급심성졸사.좌、우관상동맥공간선유문헌보도,발생솔약위인군적0.024-0.044％.좌관상동맥발자우관병분출전강지(LAD)급회선지(LCX),시일충소견적관상동맥발육기형.차충발육기형환자전강지왕왕발육세소,우관상동맥발육조대、우세.본문보도1례리환차충기형동시합병아급성심기경사병례,관맥조영급CT혈관성상증실좌관상동맥발자우관상동맥근단,좌주간장,주행우좌실전벽후분위LAD급LCX,기LAD발육소병주행우전실간구,RCA발육우세,공응좌실하、후벽급부분측벽.수연해환자성공진행택기경피관상동맥개입치료병우기RCA근단치입약물지가,단차충병례응시위좌주간병변,개입조작치료중응근신、세심.
Objective Although the majority of coronary artery anomalies are found incidentally and not clinically significant,the interarterial course between the major vessels of the aberrant artery may be responsible for syncope,angina,arrhythmias or sudden death.There are only a few case reports describing the origination of all the coronary arteries from a single ostium.This anomaly occurs in only 0.024％-0.044％ of the population.Left coronary artery originating from the fight coronary is a rare coronary abnormality.Here we report a case of acute myocardial infarction in a patient with anomalous left coronary artery originating from the right coronary artery,as was confirmed by computerized tomography angiogram,which showed that only one single coronary artery stem originating from the right sinus of Valsalva trifurcated into a right coronary artery,left circumflex artery and a hypoplastic left anterior descending artery.Subsequent percutaneous coronary intervention (PCI)procedures were performed successfully.PCI procedures should be carried out with great caution in such cases,and this condition should be managed as a left main lesion.