异常的右冠状动脉:一种强迫性心痛和鼻结缺血的病例
Edward Dababneh1, Vethahi Arunthayaparan2, Dylan Young1
1Department of Cardiology, Division of Specialist Medical Services, Gold Coast Hospital and Health Services, Southport, Queensland, Australia; Department of Medicine, Griffith University School of Medicine, Southport, Queensland, Australia.
JACC. Case reports
|November 13, 2025
概括
来自左鼻的异常右冠状动脉 (RCA) 可以导致由于鼻 (SA) 结节缺血症导致的强力胸痛和慢性限制. 手术绕道恢复了运动员的症状和心率反应.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 遗传性心脏病是一种先天性心脏病.
背景情况:
- 来自左冠状动脉鼻的异常右冠状动脉 (RCA) 是一种罕见的先天性异常.
- 鼻腔 (SA) 结节缺血症可以表现为慢性限制,这是一种在异常RCA病例中经常被忽视的症状.
研究的目的:
- 报告一个异常的RCA病例,表现为运动性胸部疼痛和长期性衰竭.
- 要突出诊断挑战和成功的手术管理这种罕见的条件.
主要方法:
- 一名35岁的运动员有炼症状,接受了计算机断层扫描冠状动脉血管学.
- 进行了多布胺应激心声扫描,以评估心脏功能和慢性反应.
- 手术干预涉及右内乳腺动脉到RCA的旁路移植.
主要成果:
- 计算机断层扫描揭示了一个非主导的异常RCA从左侧尖端产生的,具有室内循环和SA节点供应.
- 多布胺应激回声心电图重现了胸部疼痛,但显示了心率反应,没有墙壁运动异常.
- 4个月后的术后随访显示症状完全消失,慢性反应正常化.
结论:
- 非主导的异常RCA可以呈现为心痛和慢性限制,其中SA结节缺血症作为缺血等价物.
- 在这些情况下,缺血检测可能无法得出结论;识别SA节点动脉供应对于诊断和指导干预至关重要.
- 手术复血管化可以有效地治疗症状,并恢复异常RCA和SA结节缺血症患者的慢性功能.
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