儿童冠状动脉起源异常合并心肌损害临床特征及诊治分析(附72例报告)
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摘要
目的探讨冠状动脉起源异常合并心肌损害的临床特点及相应治疗策略,提高临床医师对此类疾病的认识和诊治水平。方法回顾性分析2015—2017年首都医科大学附属北京儿童医院心脏内科诊治的72例冠状动脉起源异常合并心肌损害患儿的临床资料,总结其临床特点和诊疗方法。结果本组42例(58.3%)患儿以胸痛、胸闷、心悸为主要临床表现,心电图异常以ST-T改变(62.5%)为主,超声心动图结果示13例(18.1%)患儿合并心脏扩大,4例(5.6%)合并左室收缩功能减低。冠状动脉CT血管造影检查(CTA)结果示左冠状动脉起源异常最为常见(73.6%),其次为双侧冠状动脉起源异常(13.9%),单纯右冠状动脉起源异常最少见(12.5%)。所有患儿诊治过程顺利,无死亡病例。结论冠状动脉起源异常可导致不同程度心肌供血问题,引起缺血性心肌损害,在患者的检查中更应重视CTA对冠状动脉开口位置和走行的判断,在诊断治疗中更应注意其与儿童心肌炎的鉴别。
Objective To investigate the clinical characteristics and treatment strategies of anomalous origin of the cor?onary artery accompanied with myocardial damage,so as to improve the level of clinicians' diagnosis and treatment of this disease. Methods The clinical data of 72 cases of anomalous origin of the coronary artery accompanied with myo?cardial damage admitted in Department of Cardiology,Beijing Children's Hospital,Capital Medical University from2015 to 2017 were analyzed retrospectively. The clinical characteristics,diagnosis and treatment methods were analyzed.Results In 42 cases(58.3%),chest pain,chest tightness and palpitation were the main clinical symptoms. ECG abnor?malities were mainly ST-T changes(62.5%). Echocardiography showed 13 cases(18.1%)of cardiac enlargement,4 cas?es(5.6%)of left ventricular systolic dysfunction. Coronary artery CT angiography(CTA)showed that the anomalous ori?gin of the left coronary artery was the most frequent(73.6%),followed by the anomalous origin of bilateral coronary arter?ies(13.9%),and the anomalous origin of the right coronary artery was the least frequent(12.5%). The whole group was successfully treated with no death. Conclusion There might be a correlation between the anomalous origin of coronary artery and ischemic myocardial damage. In the examination of patients,pediatricians should pay more attention to the judgments of the position and movement of the coronary artery by CTA,and attach importance to the differential diagno?sis between ischemic myocardial damage and myocarditis.
Objective To investigate the clinical characteristics and treatment strategies of anomalous origin of the cor?onary artery accompanied with myocardial damage,so as to improve the level of clinicians' diagnosis and treatment of this disease. Methods The clinical data of 72 cases of anomalous origin of the coronary artery accompanied with myo?cardial damage admitted in Department of Cardiology,Beijing Children's Hospital,Capital Medical University from2015 to 2017 were analyzed retrospectively. The clinical characteristics,diagnosis and treatment methods were analyzed.Results In 42 cases(58.3%),chest pain,chest tightness and palpitation were the main clinical symptoms. ECG abnor?malities were mainly ST-T changes(62.5%). Echocardiography showed 13 cases(18.1%)of cardiac enlargement,4 cas?es(5.6%)of left ventricular systolic dysfunction. Coronary artery CT angiography(CTA)showed that the anomalous ori?gin of the left coronary artery was the most frequent(73.6%),followed by the anomalous origin of bilateral coronary arter?ies(13.9%),and the anomalous origin of the right coronary artery was the least frequent(12.5%). The whole group was successfully treated with no death. Conclusion There might be a correlation between the anomalous origin of coronary artery and ischemic myocardial damage. In the examination of patients,pediatricians should pay more attention to the judgments of the position and movement of the coronary artery by CTA,and attach importance to the differential diagno?sis between ischemic myocardial damage and myocarditis.
引文
[1]Pursnani A,Jacobs JE,Saremi F,et al.Coronary CTA assess?ment of coronary anomalies[J].J Cardiovasc Comput Tomogr,2012,6(1):48-59.
[2]Warnes CA,Williams RG,Bashore TM,et al.ACC/AHA 2008guidelines for the management of adults with congenital heart disease:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines(writing committee to develop guidelines on the management of adults with congenital heart disease)[J].Circulation,2008,118(23):e714-833.
[3]Pursnani A,Jacobs JE,Saremi F,et al.Coronary CTA assess?ment of coronary anomalies[J].J Cardiovasc Comput Tomogr,2012,6(1):48-59.
[4]Ogden JA.Congenital anomalies of the coronary arteries[J].Am J Cardiol,1970,25(4):474-479.
[5]Molossi S,Agrawal H.Clinical evaluation of anomalous aortic or?igin of a coronary artery(AAOCA)[J].Congenit Heart Dis,2017,12(5):607-609.
[6]甄珍,袁越.儿童缺血性心肌损害研究进展[J].中国实用儿科杂志,2013,28(6):477-480.
[7]文红霞,黄小力,李敏,等.小儿病毒性心肌炎动态心电图改变的临床分析[J].华中医学杂志,2009,33(5):278-279.
[8]张菁,杨志亮,张乾忠.小儿病毒性心肌炎心电图改变及其临床意义[J].中国实用儿科杂志,2008,23(5):379-380.
[9]Caforio AL,Pankuweit S,Arbustini E,et al.Current state of knowledge on aetiology,diagnosis,management,and therapy of myocarditis:A position statement of the European Society of Car?diology Working Group on Myocardial and Pericardial Diseas?es[J].Eur Heart J,2013,34(33):2636-2648.
[10]Yamanaka O,Hobbs RE.Coronary artery anomalies in 126,595 patients undergoing coronary arteriography[J].Cathet Car?diovasc Diagn,1990,21(1):28-40.
[11]姚民,陈珏,吴元,等.成年人冠状动脉造影先天性变异分析[J].中国循环杂志,1999,14(3):132-134.
[12]李忠红,方卫华,衣为民,等.冠状动脉畸形及其临床意义[J].中国循环杂志,2003,18(5):349-351.
[13]Kim SY,Seo FB,Do KH,et al.Coronary artery anomalies:clas?sification and ECG-gated multi-detector row CT findings with angiographic correlation[J].Radiographics,2006,26(2):317-334.
[14]李建民,朱莉.冠状动脉起源异常的研究进展[J].中华临床医师杂志,2013,7(3):1205-1208.
[15]Mosca RS,Phoon CK.Anomalous aortic origin of a coronary ar?tery is not always a surgical disease[J].Semin Thorac Cardio?vasc Surg Pediatr Card Surg Annu,2016,19(1):30-36.
[2]Warnes CA,Williams RG,Bashore TM,et al.ACC/AHA 2008guidelines for the management of adults with congenital heart disease:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines(writing committee to develop guidelines on the management of adults with congenital heart disease)[J].Circulation,2008,118(23):e714-833.
[3]Pursnani A,Jacobs JE,Saremi F,et al.Coronary CTA assess?ment of coronary anomalies[J].J Cardiovasc Comput Tomogr,2012,6(1):48-59.
[4]Ogden JA.Congenital anomalies of the coronary arteries[J].Am J Cardiol,1970,25(4):474-479.
[5]Molossi S,Agrawal H.Clinical evaluation of anomalous aortic or?igin of a coronary artery(AAOCA)[J].Congenit Heart Dis,2017,12(5):607-609.
[6]甄珍,袁越.儿童缺血性心肌损害研究进展[J].中国实用儿科杂志,2013,28(6):477-480.
[7]文红霞,黄小力,李敏,等.小儿病毒性心肌炎动态心电图改变的临床分析[J].华中医学杂志,2009,33(5):278-279.
[8]张菁,杨志亮,张乾忠.小儿病毒性心肌炎心电图改变及其临床意义[J].中国实用儿科杂志,2008,23(5):379-380.
[9]Caforio AL,Pankuweit S,Arbustini E,et al.Current state of knowledge on aetiology,diagnosis,management,and therapy of myocarditis:A position statement of the European Society of Car?diology Working Group on Myocardial and Pericardial Diseas?es[J].Eur Heart J,2013,34(33):2636-2648.
[10]Yamanaka O,Hobbs RE.Coronary artery anomalies in 126,595 patients undergoing coronary arteriography[J].Cathet Car?diovasc Diagn,1990,21(1):28-40.
[11]姚民,陈珏,吴元,等.成年人冠状动脉造影先天性变异分析[J].中国循环杂志,1999,14(3):132-134.
[12]李忠红,方卫华,衣为民,等.冠状动脉畸形及其临床意义[J].中国循环杂志,2003,18(5):349-351.
[13]Kim SY,Seo FB,Do KH,et al.Coronary artery anomalies:clas?sification and ECG-gated multi-detector row CT findings with angiographic correlation[J].Radiographics,2006,26(2):317-334.
[14]李建民,朱莉.冠状动脉起源异常的研究进展[J].中华临床医师杂志,2013,7(3):1205-1208.
[15]Mosca RS,Phoon CK.Anomalous aortic origin of a coronary ar?tery is not always a surgical disease[J].Semin Thorac Cardio?vasc Surg Pediatr Card Surg Annu,2016,19(1):30-36.