Clinical Analysis Of Congenital Coronary Artery Anomaly

Objective: To investigate the characteristics of coronary artery anomalies in incidence, manifestation, diagnosis and therapeusis. Method: Coronary artery anomaly were found in 31 patients among 1655 patients who underwent angiography. 18 of them had anomalies of origin, 12 had coronary artery fistula, and 1 had coronary arteriovenous fistula. Detailed analysis of presenting symptoms, signs, angiography, echo-cardiography, electrocardiogram and chest X-ray findings was carried out. Result:(1) CAP drained into pulmonary artery in 5, right ventricle in 3, right atrium in 2, left ventricle and left atrium in 1 separately. All the patients except one had symptoms such as dyspnoea, angina, palpitation and so on. Cardiac murmur was detected in 5 patients. Chest X-ray revealed atrium or ventricle enlargement in 6. Echocardiogram revealed local weakness of myocardial motion in 2 and myocardial nuclein imaging revealed local myocardial ischemia in 1.(2) Anomalous origin of coronary arteries (AOCA) were found in 18 patients, including anomalous origins of the right coronary artery (RCA) from the posterior sinus of valsalva in 8, the left anterior descending branch (LAD) and the left circumflex branch (LCX) from the left sinus in 4, RCA from the sites above the posterior sinus in 2,double RCA in 2, LCX from the right sinus in 1, RCA from the left sinus in 1 and the left coronary artery form pulmonary artery (AJCAPA) in 1. Conclusion:(1) CAP: Although nonspecific symptoms were common and tended to develop in the fourth and fifth decade of life, a high index of suspicion were required when we met such conditions as anormal blood stream in cardiac chamber and great vessels; anormal dilataltion of coronary artery; enlargement of atrium, ventricle or pulmonary artery in patients over 40 years; cardiac murmur especially near to parasternal sites and without other heart diseases.(2) AOCA: All the patients with AOCA were coincidental findings during coronary angiography except one with ALCAPA. 3 patients also had rheumatic heart disease, and underwent manipulation of heart valve. 6 also had coronary heart disease, and 1 underwent coronary artery bypass implantation. So correct diagnosis is important for the choice and safety of surgery.