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成人型與嬰兒型左冠狀動(dòng)脈異常起源于肺動(dòng)脈的超聲診斷

2014-01-24 14:41李文秀張桂珍
中國(guó)循證兒科雜志 2014年3期
關(guān)鍵詞:主干心動(dòng)圖肺動(dòng)脈

李文秀 耿 斌 吳 江 陳 敏 張桂珍

·論著·

成人型與嬰兒型左冠狀動(dòng)脈異常起源于肺動(dòng)脈的超聲診斷

李文秀1耿 斌1吳 江1陳 敏2張桂珍1

目的 總結(jié)不同類型左冠狀動(dòng)脈異常起源于肺動(dòng)脈(ALCAPA)的超聲心動(dòng)圖表現(xiàn),提高對(duì)本病的診斷及鑒別診斷能力。方法 回顧性分析首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院兒童心血管病中心收治并經(jīng)手術(shù)證實(shí)的24例ALCAPA患兒的超聲心動(dòng)圖結(jié)果,根據(jù)側(cè)支循環(huán)的發(fā)育情況分為嬰兒型和成人型,并總結(jié)嬰兒型和成人型ALCAPA的超聲心動(dòng)圖特征。結(jié)果 嬰兒型和成人型ALCAPA相同的超聲心動(dòng)圖特征:①左冠狀動(dòng)脈竇內(nèi)無左冠狀動(dòng)脈主干開口,其主干直接與肺動(dòng)脈連接;②左心室高度擴(kuò)張,室間隔和左室前壁節(jié)段性運(yùn)動(dòng)障礙,左室收縮功能減低;③左心室廣泛纖維化,以心內(nèi)膜下區(qū)域最為顯著;④二尖瓣腱索、乳頭肌纖維化,回聲顯著增強(qiáng);⑤右冠狀動(dòng)脈起源位置正常,內(nèi)徑增寬;⑥左冠狀動(dòng)脈前降支和回旋支血流為逆向灌注(向心性);⑦收縮期二尖瓣口可見少至大量反流信號(hào)。嬰兒型和成人型ALCAPA不同的超聲心動(dòng)圖表現(xiàn):彩色多普勒顯示成人型側(cè)支循環(huán)血流豐富,嬰兒型側(cè)支循環(huán)少。結(jié)論 嬰兒型和成人型ALCAPA具有其特異性的超聲心動(dòng)圖特征,結(jié)合其臨床及心電圖等表現(xiàn),可以對(duì)本病做出正確診斷。

左冠狀動(dòng)脈異常起源于肺動(dòng)脈; 超聲心動(dòng)圖; 側(cè)支循環(huán)

左冠狀動(dòng)脈異常起源于肺動(dòng)脈(ALCAPA)是一種發(fā)病率極低的先天性冠狀動(dòng)脈起源異常,文獻(xiàn)報(bào)道ALCAPA在嬰幼兒中發(fā)病率約為1/30萬[1],占先天性心臟病的0.25%~0.50%[2],是導(dǎo)致嬰幼兒心肌缺血、心肌梗死的常見病因之一[3],手術(shù)是根治本病的唯一手段[4,5]。根據(jù)冠狀動(dòng)脈間側(cè)支血管發(fā)育的情況,ALCAPA分為嬰兒型和成人型[6],嬰兒型冠狀動(dòng)脈間側(cè)支血管發(fā)育差,臨床癥狀嚴(yán)重,未行手術(shù)治療的嬰兒型患兒1歲內(nèi)病死率高達(dá)90%[7];成人型側(cè)支血管發(fā)育豐富,癥狀較輕,部分患兒可生存至成年,但若治療不及時(shí),最終會(huì)死于心力衰竭或心源性猝死[7]。中國(guó)自20世紀(jì)80年代開始逐漸對(duì)ALCAPA進(jìn)行了報(bào)道,但例數(shù)較少,臨床醫(yī)生及影像學(xué)醫(yī)生對(duì)其認(rèn)識(shí)有限,多數(shù)病例被誤診或漏診,耽誤了患兒的治療。目前,先天性心臟病首選的檢查方法仍然是超聲心動(dòng)圖,因此,臨床醫(yī)生特別是超聲醫(yī)生應(yīng)該對(duì)ALCAPA的超聲心動(dòng)圖表現(xiàn)有全面的認(rèn)識(shí),減少誤診及漏診。本文通過回顧性總結(jié)嬰兒型和成人型ALCAPA的超聲心動(dòng)圖特征,以期全面認(rèn)識(shí)并提高對(duì)本病的診斷及鑒別診斷能力。

1 方法

1.1 診斷標(biāo)準(zhǔn)及分型 ALCAPA是指左冠狀動(dòng)脈主干或其分支(左前降冠狀動(dòng)脈或左回旋冠狀動(dòng)脈)起源于近端肺動(dòng)脈干或極少數(shù)起源于近端右肺動(dòng)脈[3]。根據(jù)冠狀動(dòng)脈間側(cè)支血管發(fā)育的情況分為嬰兒型和成人型[6]。

1.2 納入標(biāo)準(zhǔn) 1997年1月至2013年10月首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院兒童心血管病中心住院并經(jīng)手術(shù)證實(shí)診斷為ALCAPA的連續(xù)病例。

1.3 病歷資料截取 截取手術(shù)前病史中的以下資料用于本文分析:①一般情況:年齡、性別和生長(zhǎng)發(fā)育情況(依據(jù)不同年齡段、不同性別正常兒童的身高/年齡、體重/年齡標(biāo)準(zhǔn)差數(shù)值表[8]評(píng)判);②臨床資料:臨床癥狀和體征,合并其他心臟畸形,ECG,影像學(xué)檢查(胸部X線片和超聲心動(dòng)圖等),誤診疾??;③預(yù)后。

1.4 超聲心動(dòng)圖檢查 采用HP5000、AcusonSequioa 512、Philips IE33彩色超聲診斷儀,選擇探頭S5-1,頻率1~5 MHz;嬰幼兒冠狀動(dòng)脈顯示不滿意時(shí)選用探頭S12-4,頻率4~12 MHz。受檢者取平臥位、左側(cè)臥位或右側(cè)臥位;常規(guī)超聲心動(dòng)圖探查心內(nèi)結(jié)構(gòu)及瓣膜反流情況,通過室壁運(yùn)動(dòng)情況評(píng)價(jià)左室功能。應(yīng)用二維超聲多切面重點(diǎn)探查左、右冠狀動(dòng)脈的起源部位、走行、內(nèi)徑及肺動(dòng)脈與左冠狀動(dòng)脈的關(guān)系;應(yīng)用彩色多普勒超聲重點(diǎn)觀察左、右冠狀動(dòng)脈內(nèi)血流方向及肺動(dòng)脈內(nèi)的異常血流,左、右冠狀動(dòng)脈之間側(cè)支循環(huán)情況及肺動(dòng)脈主干內(nèi)有無冠狀動(dòng)脈異常的逆灌血流。

2 結(jié)果

2.1 一般情況 24例ALCAPA患兒進(jìn)入本文分析,其中男8例,女16例。嬰兒型9例,年齡3個(gè)月至4歲6個(gè)月,中位年齡8.5個(gè)月;成人型15例,年齡1歲2個(gè)月至16歲10個(gè)月,中位年齡60個(gè)月。左冠狀動(dòng)脈起源于肺動(dòng)脈左后竇11例,起源于肺動(dòng)脈右后竇6例,其他7例。5例合并卵圓孔未閉,3例合并壁內(nèi)冠狀動(dòng)脈。24例均行手術(shù)治療,死亡5例,其中嬰兒型4例,成人型1例。

2.2 誤診情況 24例ALCAPA患兒中,曾誤診為心內(nèi)膜彈力纖維增生癥7例(嬰兒型4例,成人型3例);原發(fā)性擴(kuò)張性心肌病3例(嬰兒型2例,成人型1例);右冠狀動(dòng)脈-肺動(dòng)脈瘺2例(均為成人型);瓣膜病1例(成人型)。

2.3 臨床癥狀和體征 24例均有活動(dòng)耐量低,活動(dòng)后心慌、氣短,胸悶,平素多汗等癥狀。所有患兒均無青紫。心尖部均可聞及2~3/6級(jí)收縮期雜音。生長(zhǎng)發(fā)育落后6例(嬰兒型和成人型各3例)。1例成人型患兒就診前1年出現(xiàn)過暈厥癥狀。

2.4 影像學(xué)檢查

2.4.1 胸部X線片 肺血增多10例(嬰兒型3例,成人型7例),肺紋理增粗3例(嬰兒型2例,成人型1例),肺血減少2例(嬰兒型和成人型各1例)。

2.4.2 ECG 16例出現(xiàn)左心室前側(cè)壁心肌梗死心電圖表現(xiàn),Ⅰ導(dǎo)聯(lián)異常Q波12例(嬰兒型7例,成人型5例),avL導(dǎo)聯(lián)異常Q波16例(嬰兒型和成人型各8例),V4~V6導(dǎo)聯(lián)異常Q波15例(嬰兒型8例,成人型7例)。24例均有ST-T波壓低。

2.4.3 超聲心動(dòng)圖 術(shù)前超聲心動(dòng)圖測(cè)量結(jié)果顯示,嬰兒型和成人型患兒心功能差異有統(tǒng)計(jì)學(xué)意義,左、右冠狀動(dòng)脈主干與主動(dòng)脈環(huán)直徑比值差異無統(tǒng)計(jì)學(xué)意義(表1)。

嬰兒型和成人型ALCAPA患兒相同的超聲心動(dòng)圖表現(xiàn):①主動(dòng)脈左冠狀動(dòng)脈竇內(nèi)無左冠狀動(dòng)脈主干開口,左冠狀動(dòng)脈主干直接與肺動(dòng)脈連接(圖1A),彩色多普勒可清晰顯示異常起源的左冠狀動(dòng)脈主干開口(圖1B);②左心室高度擴(kuò)張,以心尖區(qū)擴(kuò)大更為明顯,室間隔和左室前壁節(jié)段性運(yùn)動(dòng)障礙,左室收縮功能減低(圖1C);③左心室廣泛纖維化,以心內(nèi)膜下區(qū)域最為顯著,嚴(yán)重者可出現(xiàn)一定范圍的心肌梗死病灶,4例(嬰兒型3例,成人型1例)合并心尖部室壁瘤形成(局部室壁擴(kuò)張、變薄,病變區(qū)薄層的心室壁向外膨出,心臟收縮時(shí)喪失活動(dòng)能力或呈現(xiàn)反常運(yùn)動(dòng));④二尖瓣腱索、乳頭肌纖維化,回聲顯著增強(qiáng),可伴有二尖瓣脫垂(圖1D);⑤右冠狀動(dòng)脈起源位置正常,內(nèi)徑增寬;⑥左冠狀動(dòng)脈前降支和回旋支血流為逆向灌注(向心性)(圖1E);⑦收縮期二尖瓣口可見少至大量反流信號(hào)(圖1F)。

嬰兒型與成人型ALCAPA患兒不同的超聲心動(dòng)圖表現(xiàn):成人型側(cè)支循環(huán)豐富,彩色多普勒顯示左、右冠狀動(dòng)脈之間側(cè)支循環(huán)血流豐富(圖1G);嬰兒型側(cè)支循環(huán)差,彩色多普勒顯示左、右冠狀動(dòng)脈之間稀疏的側(cè)支循環(huán),彩色血流暗淡(圖1H)。

圖1 嬰兒型和成人型ALCAPA超聲心動(dòng)圖表現(xiàn)

Fig 1 The features of echocardiography of different types of ALCAPA

Notes A: There was no ostium of main LCA in the left coronary sinus of aorta on the left side high parasternal section.The anterior descending and left circumflex of LCA were shown clearly on two-dimensional ultrasound; B: Color Doppler showed the inverse red color flow from LCA to PA; C: The LV was enlarged; D: The ultrasonography of ALCAPA, the chamber of LV and LA were enlarged and the echo of mitral valve tendon was enhanced (arrow) on parasternal left ventricular long axis section; E: Color Doppler showed the inverse color flow in LAD and LCx at the diastole phase; F: Color Doppler showed moderate mitral valve regurgitation; G: The significant collateral vessels were established between the RCA and LCA (arrow)on apex four chamber view; H: The ultrasonography of infantile types of ALCAPA, the small and thin collateral vessels (arrow)were established between the RCA and LCA on left ventricular short axis view. LCA: left coronary artery; PA: pulmonary artery; AO: aortic; RCA: right coronary artery; LAD: anterior descending of left coronary artery; LCx: left circumflex of left coronary artery; LV: left ventricle; RV: right ventricle; LA: left atrium; RA: right atrium

3 討論

ALCAPA是一種罕見的冠狀動(dòng)脈起源異常,雖然文獻(xiàn)報(bào)道其發(fā)病率非常低,但在臨床工作中發(fā)現(xiàn)部分ALCAPA患兒常被漏診及誤診,因此ALCAPA的發(fā)病率可能被低估。究其原因是臨床醫(yī)生和超聲醫(yī)生對(duì)ALCAPA認(rèn)識(shí)有限,特別是超聲醫(yī)生對(duì)ALCAPA的超聲心動(dòng)圖表現(xiàn)未完全掌握,同時(shí)由于嬰兒型和成人型的ALCAPA超聲心動(dòng)圖表現(xiàn)存在不同之處,而且ALCAPA在不同時(shí)期的病理生理學(xué)改變不同,因此更易造成臨床漏診或誤診。

嬰兒型發(fā)病率較高,冠狀動(dòng)脈間側(cè)支血管發(fā)育差,癥狀嚴(yán)重,心肌收縮無力,常于早期因心力衰竭而夭折,部分患兒嬰兒期出現(xiàn)心力衰竭癥狀后,經(jīng)內(nèi)科保守治療后癥狀好轉(zhuǎn),而在治療階段,冠狀動(dòng)脈側(cè)支血管逐漸形成增多,這部分患兒仍歸為嬰兒型。成人型發(fā)病率較低,側(cè)支血管豐富,癥狀較輕,在嬰兒期無癥狀,僅勞累后出現(xiàn)心絞痛等癥狀,往往在偶然檢查中發(fā)現(xiàn)心臟增大或以心臟雜音就診[9]。本文嬰兒型病例較少(9/24),考慮嬰兒型患兒發(fā)病較早,癥狀較重,部分患兒未經(jīng)明確診斷及治療即夭折。此外,本文未納入我院門診確診,但左室收縮功能低,暫時(shí)不能進(jìn)行外科治療的嬰兒型病例。

不同時(shí)期ALCAPA病理生理學(xué)改變不同[6,10]。新生兒期,由于肺循環(huán)壓力和阻力均較高,肺動(dòng)脈內(nèi)的低氧血流可經(jīng)異常起源的左冠狀動(dòng)脈正向灌注左室心肌,雖然此時(shí)左室心肌血氧飽和度降低,但血流量仍能保持正常灌注,血流方向?yàn)橛夜跔顒?dòng)脈→側(cè)支循環(huán)→左冠狀動(dòng)脈,再加上新生兒未成熟的心肌耐受缺氧能力高于耐低壓能力,因此,新生兒期ALCAPA患兒可不出現(xiàn)明顯的心肌缺血癥狀,可僅表現(xiàn)為多汗癥狀。出生后3個(gè)月,隨著新生兒肺動(dòng)脈壓力的逐漸下降,左冠狀動(dòng)脈灌注壓嚴(yán)重不足,常出現(xiàn)逆向灌注,即右冠狀動(dòng)脈血流通過冠狀動(dòng)脈間的側(cè)支循環(huán)逆向灌注到左冠狀動(dòng)脈后,再經(jīng)左冠狀動(dòng)脈的異常開口將血流逆向灌注到壓力更低的肺動(dòng)脈內(nèi),此時(shí)血流方向?yàn)橛夜跔顒?dòng)脈→側(cè)支循環(huán)→左冠狀動(dòng)脈→肺動(dòng)脈,此時(shí)心肌會(huì)出現(xiàn)缺血癥狀,若患兒側(cè)支血管發(fā)育差或側(cè)支發(fā)育不及時(shí),癥狀會(huì)非常嚴(yán)重,可表現(xiàn)為平素氣促、易嗆奶、多汗和生長(zhǎng)發(fā)育遲緩等癥狀,即嬰兒型ALCAPA。當(dāng)患兒冠狀動(dòng)脈間及時(shí)建立側(cè)支循環(huán),并且側(cè)支血管豐富時(shí),大量血流通過豐富的側(cè)支灌注到左室的前壁和側(cè)壁,心肌缺血癥狀可得到一定程度的緩解,多數(shù)患兒出現(xiàn)癥狀較晚,可有胸悶、活動(dòng)后氣促、勞累后心絞痛和慢性充血性心力衰竭等癥狀,部分患兒癥狀不明顯,多在成年后偶然檢查發(fā)現(xiàn),即成人型ALCAPA。

嬰兒型和成人型ALCAPA患兒具有相同的超聲心動(dòng)圖及ECG表現(xiàn),這與其病理及病理生理改變密切相關(guān)。本病根本的病因?yàn)樽蠊跔顒?dòng)脈主干與肺動(dòng)脈異常連接,其最常見的異常起源部位是肺動(dòng)脈左后竇,其次為右后竇;由于心肌缺血,可導(dǎo)致心內(nèi)膜的供血不足而產(chǎn)生心內(nèi)膜彈性纖維組織增生、纖維化、乳頭肌功能失調(diào)、二尖瓣鍵索的融合和縮短,超聲心動(dòng)圖表現(xiàn)為左心室高度擴(kuò)張、心內(nèi)膜及二尖瓣腱索回聲明顯增強(qiáng),此外,纖維化還可導(dǎo)致心臟增大呈球形擴(kuò)大及二尖瓣環(huán)擴(kuò)大,最終導(dǎo)致不同程度的左室收縮功能減低及二尖瓣關(guān)閉不全,聽診時(shí)心前區(qū)即出現(xiàn)收縮期二尖瓣反流產(chǎn)生的雜音,ECG出現(xiàn)左心室前側(cè)壁心肌梗死表現(xiàn),即Ⅰ、avL、V4~V6導(dǎo)聯(lián)深寬Q波;部分患兒出現(xiàn)心肌缺血表現(xiàn),即ST-T波壓低;部分患兒還可形成室壁瘤,本文4例患兒合并心尖部室壁瘤形成。由于右冠狀動(dòng)脈是唯一供應(yīng)心肌血液的動(dòng)脈,因此右冠狀動(dòng)脈代償性的內(nèi)徑增寬,而冠狀動(dòng)脈前降支和回旋支血流為逆向灌注(向心性)。

嬰兒型ALCAPA超聲心動(dòng)圖及臨床表現(xiàn)與心內(nèi)膜彈力纖維增生癥(EFE)和先天性左冠狀動(dòng)脈主干閉鎖(LMCAA)相似[11],因此常被誤診為EFE和LMCAA;成人型ALCAPA超聲心動(dòng)圖及臨床表現(xiàn)與原發(fā)性擴(kuò)張性心肌病(DCM)、瓣膜疾病和冠狀動(dòng)脈瘺等相似[12~14]。本文13例患兒曾被誤診,究其原因是對(duì)ALCAPA認(rèn)識(shí)不足,因此,超聲醫(yī)生對(duì)懷疑EFE、DCM、瓣膜疾病和冠狀動(dòng)脈瘺患兒的檢查過程中,要多切面、多角度對(duì)冠狀動(dòng)脈進(jìn)行重點(diǎn)檢查,減少漏診及誤診。

在ALCAPA的超聲心動(dòng)圖表現(xiàn)中,二尖瓣腱索、乳頭肌回聲增強(qiáng)是具有指導(dǎo)意義的超聲表現(xiàn),有研究者認(rèn)為乳頭肌回聲增強(qiáng)是鑒別ALCAPA和DCM的重要指標(biāo)[7,15],本文的臨床體會(huì)也認(rèn)為這一超聲表現(xiàn)對(duì)診斷ALCAPA有重要的意義,當(dāng)超聲心動(dòng)圖檢查發(fā)現(xiàn)二尖瓣腱索、乳頭肌回聲增強(qiáng)時(shí)應(yīng)重點(diǎn)觀察冠狀動(dòng)脈的情況,如果還同時(shí)具有ECG的相關(guān)表現(xiàn),則對(duì)超聲醫(yī)生診斷ALCAPA有進(jìn)一步的提示作用,最終可準(zhǔn)確診斷。

本文不同類型ALCAPA患兒術(shù)前超聲心動(dòng)圖檢查結(jié)果顯示,成人型術(shù)前心功能正常,嬰兒型術(shù)前心功能明顯減低,差異有統(tǒng)計(jì)學(xué)意義,而左、右冠狀動(dòng)脈主干與主動(dòng)脈環(huán)直徑比值差異均無統(tǒng)計(jì)學(xué)意義。但本文嬰兒型僅9例,因此各項(xiàng)超聲心動(dòng)圖參數(shù)有待于增加病例后進(jìn)一步研究。

ALCAPA最終的治療方式是重建兩個(gè)冠狀動(dòng)脈系統(tǒng)的外科手術(shù)。目前的理論認(rèn)為無論是嬰兒型或成人型的ALCAPA,即使患兒沒有癥狀也應(yīng)盡早手術(shù),才能解決肺動(dòng)脈從左冠狀動(dòng)脈竊血的問題,從而進(jìn)一步避免心肌的缺血損傷,預(yù)防乳頭肌功能失調(diào)的發(fā)生,并最終改善左心功能和預(yù)防心力衰竭或猝死的發(fā)生,但臨床工作中常會(huì)遇到各種情況導(dǎo)致手術(shù)治療的延誤。

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[2] Pfannschmidt J, Ruskowski H, de Vivie ER. Bland-White-Garland syndrome: clinical aspects, diagnosis, therapy. Klin Padiatr,1992, 204(5): 328-334

[3] 朱曉東,主編.心臟外科學(xué).先天性冠狀動(dòng)脈畸形.第一版.北京:人民衛(wèi)生出版社,2007.533-549

[4] Ojala T, Salminen J, Happonen JM, et al. Excellent functional result in children after correction of anomalous origin of left coronary artery from the pulmonary artery--a population based complete follow-up study. Interact Cardiovasc Thorac Surg, 2010,10(1):70-75

[5] Mainwaring RD, Reddy VM, Reinhartz O,et al. Anomalous aortic origin of a coronary artery: medium-term results after surgical repair in 50 patients. Ann Thorac Surg, 2011,92(2):691-697

[7] Tan X(譚曉), Sun K, Li F, et al. Clinical diagnosis of anomalous origin of the left coronary artery from the pulmonary artery in 22 cases.Chin J Pediatr(中華兒科雜志), 2008,46(12):881-884

[8] WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards based on length/height, weight and age.Acta Paediatr Suppl, 2006,450:76-85

[9] Wesselhoeft H, Fawcett JS, Johnson AL. Anomalous origin of the left coronary artery from the pulmonary trunk: its clinical spectrum, pathology, andpathophysiology, based on a review of 140 cases with seven further cases. Circulation, 1968,38(2):403-425

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[12] Hallioglu O, Karag?z T, Celiker A. Adult type anomalous origin of the left coronary artery from the pulmonary artery.Turk J Pediatr,2004,46(1):92-94

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(本文編輯:張萍)

The echocardiography diagnosis of infantile and adult types of anomalous origin of the left coronary artery from the pulmonary artery

LI Wen-xiu1, GENG Bin1, WU Jiang1, CHEN Min2, ZHANG Gui-zheng1

(1 Pediatric Cardiovascular Center,Beijing Anzhen Hospital affiliated to the Capital Medical University, Beijing 100029, China; 2 Department of Ultrasound, PLA 302 Hospital, Beijing 100089, China)

GENG Bin,E-mail:geng_bin1@163.com

ObjectiveTo improve the diagnosis and differential diagnosis ability for different type of anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA) by summarizing patient's echocardiography features and in combination with its clinical and electrocardiogram performances. MethodsThe echocardiography results of twenty-four cases with confirmed diagnosis of ALCAPA by surgery were retrospectively reviewed. According to the development of coronary artery collateral circulation, patients were divided into infantile type and adult type. The different and the common echocardiography features were summarized in two types of ALCAPA. ResultsThe same echocardiography features of infantile and adult types: ①There was no left main coronary artery ostium in left coronary cusp, in stead, the left coronary artery(LCA) was originated from pulmonary artery. ②Left ventricle chamber was enlarged obviously. The segments movement of interventricular septum and anterior wall of left ventricle was disorderd. The systolic function of left ventricle was reduced. ③The fibrosis of left ventricle was extensive and the area of endocardium was significant. ④The echo of mitral chordae tendineae and papillary muscle was enhanced. ⑤The diameter of right coronary artery (RPA) was significantly dilated. ⑥The flow of left coronary descending and circumflex branch was inversed. ⑦The mitral regurgitation was mild or severe. The following features differed in infantile and adult types. The significant collateral vessels were established between the RCA and LCA in adult type, however it was not the case for infantile type. The collateral vessels were less in infantile type.ConclusionThe different types of ALCAPA have some specific echocardiography features. Combining patient's echocardiography features with clinical and electrocardiogram performances, the accurate diagnosis can be achieved.

Anomalous origin of the left coronary artery from the pulmonary artery; Echocardiography; Collateral circulation

1 首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院兒童心血管病中心 北京,100029;2 中國(guó)人民解放軍第302醫(yī)院超聲科 北京,100089

耿斌,E-mail:geng_bin1@163.com

10.3969/j.issn.1673-5501.2014.03.006

2014-03-07

2014-05-25)

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