以呼吸道感染为首发症状的左冠状动脉起源于肺动脉一例

Abstract

目的：探讨左冠状动脉起源于肺动脉的病因，诊断和治疗。方法：对我科住院的一例左冠状动脉起源于肺动脉患儿的临床资料进行回顾性分析。结果：患者因反复呼吸道感染住院，查体发现心尖部杂音，心电图有TV4-6双向及ST段压低表现，呼吸道感染控制后进一步进行超声心动检查提示左冠状动脉异常起源于肺动脉？左心室增大，室壁节段性运动异常，二尖瓣反流(中度)。出院后于心脏专科医院进行增强CT检查提示冠状动脉起源异常，左心增大，左室心肌缺血性改变。进行“左冠状动脉直接再种植术 + 二尖瓣成形术”后恢复良好。结论：在临床工作中，在发现患者有反复呼吸道感染等非特异性的心功能不全表现及心脏杂音时，如果心电图有心肌缺氧表现，应注意存在此病的可能，及时进行超声心动或者MDCT检查确诊。 Objective: To investigate the causes, diagnosis and therapy of anomalous origin of the left coronary artery from the Pulmonary artery (ALCAPA). Method: The clinical data of one infant with the disease of ALCAPA in our department were retrospectively analyzed. Result: The infant was advised to be hospitalized because of frequently respiratory infections. A heart murmur was heard at the apex. ECG suggests that T waves of V4-6 were bidirectional and the S-T segments descent. Echocardiogram suggests anomalous of the left coronary artery originates from the Pulmonary artery? The left ven-tricular enlarges; Regional wall motion is abnormal and moderate mitral regurgitates. Enhanced computed tomography (CT) suggests abnormal origin of the left coronary artery, left heart’s en-largement, and left ventricular myocardial ischemia. Finally the infant accepted the surgery of transplantation of the left coronary artery and mitral valvuloplasty. The infant recovered well after operation. Conclusion: in clinical work, if nonspecific symptoms of cardiac insufficiency were like frequently respiratory infections and heart murmur was found, ECG suggests myocardial ischemia, ALCAPA should be taken into consideration. And the echocardiogram or enhanced computed to-mography examination can make a definite diagnosis.