左冠状动脉异常起源于肺动脉的CT诊断

发布时间：2018-08-03 12:08

【摘要】：目的探讨左冠状动脉异常起源于肺动脉(ALCAPA)的CT表现特征。方法回顾性分析CT诊断为ALCAPA并经手术矫正治疗的29例患者的临床和影像资料,着重观察左冠状动脉开口位置、冠状动脉管腔扩张、侧支血管的建立及分布、以及左房室大小、心肌灌注情况。结果 CT对29例ALCAPA均做出明确诊断,清晰显示左冠状动脉起源于主肺动脉,其中21例起源于肺动脉左后窦,2例起源于肺动脉右后窦,1例起源于肺动脉前窦,5例起源于主肺动脉右侧壁;19例可见左冠状动脉向肺动脉内供血,其中13例呈喷射样改变;右冠状动脉迂曲扩张27例,单纯扩张1例,1例管径无扩张,左冠状动脉迂曲扩张13例,单纯扩张14例,2例管径无扩张;10例无明确侧支血管或仅少量侧支血管,19例侧支血管丰富,分布于室间隔、圆锥前、右室侧壁及心脏膈面;心外侧支13例,均为支气管动脉侧支,12例与回旋支相通,1例与前降支相通;13例左室壁心内膜下灌注减低;2例室壁变薄;左心室扩大26例,左心房增大20例;12例左心室乳头肌或腱索钙化;16例肺动脉增宽。结论 CT能够直观显示ALCAPA异常起源的部位,并能够显示出肺动脉内对比剂的喷射征像及染色样改变等提示左向右分流的特征性征象,同时可显示冠状动脉扩张、心内外侧支血管、心肌缺血及左房室增大等伴随的间接改变。
[Abstract]:Objective to investigate the CT features of anomalous origin of left coronary artery originated from pulmonary artery (ALCAPA). Methods the clinical and imaging data of 29 patients with ALCAPA diagnosed by CT and treated by surgical correction were analyzed retrospectively. The location of left coronary artery opening, coronary artery dilatation, establishment and distribution of collateral vessels, and the size of left atrioventricular were observed. Myocardial perfusion. Results 29 cases of ALCAPA were clearly diagnosed by CT, showing clearly that the left coronary artery originated from the main pulmonary artery. 21 cases originated from left posterior sinus of pulmonary artery 2 cases originated from right posterior sinus of pulmonary artery 1 case originated from anterior sinus of pulmonary artery 5 cases originated from right wall of main pulmonary artery 19 cases showed left coronary artery supplying to pulmonary artery 13 of them showed jet like change. There were 27 cases of right coronary tortuous dilatation, 1 case of simple dilatation without dilatation, 13 cases of left coronary artery dilatation, 14 cases of dilatation of 14 cases without dilatation of vessel diameter, 10 cases without definite collateral vessels or only a few collateral vessels, 19 cases with abundant collateral vessels. It was distributed in septum, anterior cone, lateral wall of right ventricle and phrenic surface of heart, lateral branch of cardiac artery in 13 cases, collateral branch of bronchial artery in 12 cases and circumflex branch in 1 case, and inferior endocardial perfusion of left ventricular wall in 13 cases, left ventricular wall became thinner in 2 cases. Left ventricle dilated in 26 cases, left atrial enlargement in 20 cases, left ventricular papillary muscle or tendon cord calcification in 12 cases, pulmonary artery widening in 16 cases. Conclusion CT can visualize the location of abnormal origin of ALCAPA and show the characteristic signs of left to right shunt and coronary artery dilatation. Indirect changes in collateral vessels, myocardial ischemia and left atrioventricular enlargement.
【作者单位】：山东省胜利油田中心医院CT检查科;北京阜外医院放射科;
【分类号】：R543;R816.2

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