PDF(Pubmed)
Abstract：
Atypical aortic origin of coronary artery (AAOCA) is a rare heart condition that has been identified in only a few autopsy cases and in some patients who have undergone angiographic evaluation. AAOCA is known to be closely linked with aortic valve malformations, with the most common type being the bicuspid aortic valve (BAV). A 77-year-old male with a medical history of hypertension and diabetes presented with dyspnea and orthopnea for three days. During the eventual cardiac catheterization, it was noted that the left coronary artery had an anomalous origin from the right side, coursing between the aorta and pulmonary artery. Contrast-enhanced computerized tomography (CECT) also showed a type 2 BAV and a left main coronary artery arising lower at the level of the pulmonary trunk. The dyspnea in this patient was attributed to diastolic dysfunction, and surgical correction of the coronaries was not done. The patient was managed on an outpatient basis for heart failure. In this case, the patient had an anomalous origin of the left coronary artery and type 2 BAV, which posed significant cardiovascular complications. It is unclear if the presence of the concomitant type 2 BAV led to the origin of the anomalous left coronary artery being at a lower level through its effect on the developmental mechanics. This lower origin may have resulted in lower compressive forces on the coronary artery as the inter-arterial pressures would be lower closer to the heart and farther from the lungs. Our case report aims to highlight this complex presentation where the BAV likely provides a benefit in AAOCA cases.
摘要：
冠状动脉非典型主动脉起源（AAOCA）是一种罕见的心脏病，仅在少数尸检病例和一些接受血管造影评估的患者中发现。已知AAOCA与主动脉瓣畸形密切相关，最常见的类型是二叶主动脉瓣（BAV）。一名77岁男性，有高血压和糖尿病病史，出现呼吸困难和端坐呼吸三天。在最终的心脏导管插入术中,注意到左冠状动脉从右侧异常起源，在主动脉和肺动脉之间.对比增强计算机断层扫描（CECT）还显示2型BAV和左主冠状动脉在肺动脉干水平较低。该患者的呼吸困难归因于舒张功能障碍，并没有对冠状动脉进行手术矫正。患者在门诊治疗心力衰竭。在这种情况下,患者左冠状动脉异常起源和2型BAV，造成了严重的心血管并发症。尚不清楚伴随的2型BAV的存在是否通过其对发育力学的影响而导致异常左冠状动脉的起源处于较低水平。这种较低的起源可能已经导致冠状动脉上的较低的压缩力,因为动脉间压力在更靠近心脏和更远离肺部时会较低。我们的病例报告旨在强调这种复杂的演示，其中BAV可能在AAOCA病例中提供益处。
