左冠状动脉异常起源于主肺动脉综合征1例并文献复习

doi:10.3969/j.issn.1004-583X.2023.07.006

摘要/Abstract

摘要：

目的探讨老年左冠状动脉异常起源于主肺动脉(bland-white-garland,BWG)综合征的诊断和治疗。方法回顾性分析老年BWG综合征患者1例,并复习相关文献。结果患者男,66岁,近2年反复出现间断胸闷、气短,劳累后明显,休息不缓解。完善心脏彩超和冠状动脉CT血管成像(CT angiography,CTA)后,明确诊断为BWG综合征,综合评估病情,予药物治疗后好转出院。随访1年未发生心血管不良事件。结论老年BWG综合征罕见,易临床上漏诊,且误诊率高,需结合其他影像学检查确诊。对于无症状或症状轻微的老年患者,手术的风险可能超过潜在的益处,可考虑使用血管扩张剂及抗心律失常等药物治疗,并预防患者死亡。

关键词: 左冠状动脉异常, 肺动脉, 老年人

Abstract:

Objective To explore the diagnosis and treatment of the anomalous left coronary artery from the pulmonary artery (also known as Bland-White-Garland [BWG] syndrome) in the elderly. Methods A retrospective analysis was performed on an elderly patient with BWG syndrome, and the relevant literature was reviewed. Results A 66-year-old male patient presented repeated intermittent chest tightness and shortness of breath within the past 2 years, which was aggravated after exertion and not relieved after rest. Color Doppler ultrasound of the heart and computed tomography angiography (CTA) of the coronary artery confirmed the diagnosis of BWG syndrome. After a comprehensive assessment, the patient was managed by a conservative treatment of medications, and he was recovered well and discharged. During the 1-year follow-up, no adverse cardiovascular events were reported. Conclusion BWG in the elderly is rare, which is easily to be misdiagnosed or missed diagnosed. The diagnosis of BWG depends on multiple imaging examinations. For asymptomatic or mildly symptomatic elderly patients, the risks of surgery may outweigh the potential benefits, and conservative treatment with vasodilators and antiarrhythmic drugs may be used to prevent death.

Key words: abnormal left coronary artery, pulmonary artery, elderly

中图分类号:

R541.1

刘铎, 李燕玲, 郭朝霞, 李建锋, 张惠娟, 谢萍. 左冠状动脉异常起源于主肺动脉综合征1例并文献复习[J]. 临床荟萃, 2023, 38(7): 618-622.

Liu Duo, Li Yanling, Guo Zhaoxia, Li Jianfeng, Zhang Huijuan, Xie Ping. Anomalous left coronary artery from the pulmonary artery: A case report and literature review[J]. Clinical Focus, 2023, 38(7): 618-622.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.07.006

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I7/618

图/表 1

图1 左冠状动脉异常起源于主肺动脉 a.原左冠状动脉位置可探及异常逆向灌注血流(蓝色血流信号);b.异常舒张期左冠状动脉灌注血流频谱(基线水平下方);c.左冠状动脉异常起源于肺动脉主干;d.圆锥支与左冠状动脉前降支相沟通

Fig. 1 Representative scans of the anomalous left coronary artery from the pulmonary artery a. Abnormal retrograde perfusion of the blood flow (blue signal indicated by the red arrow) in the localization of the original left coronary artery; b. Spectral Doppler of the abnormal Left ventricular myocardial perfusion in diastole (below baseline level); c. The left coronary artery abnormally originated from the pulmonary artery; d The conus branch communicates with the left anterior descending artery

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