Abstract:

Objective　To investigate the clinical characteristics and treatment strategies of anomalous origin of the coronary artery accompanied with myocardial damage，so as to improve the level of clinicians’ diagnosis and treatment of this disease. Methods　The clinical data of 72 cases of anomalous origin of the coronary artery accompanied with myocardial damage admitted in Department of Cardiology，Beijing Children’s Hospital，Capital Medical University from 2015 to 2017 were analyzed retrospectively. The clinical characteristics，diagnosis and treatment methods were analyzed. Results　In 42 cases（58.3%），chest pain，chest tightness and palpitation were the main clinical symptoms. ECG abnormalities were mainly ST-T changes（62.5%）. Echocardiography showed 13 cases（18.1%） of cardiac enlargement，4 cases（5.6%） of left ventricular systolic dysfunction. Coronary artery CT angiography（CTA） showed that the anomalous origin of the left coronary artery was the most frequent（73.6%），followed by the anomalous origin of bilateral coronary arteries（13.9%），and the anomalous origin of the right coronary artery was the least frequent（12.5%）. The whole group was successfully treated with no death. Conclusion　There might be a correlation between the anomalous origin of coronary artery and ischemic myocardial damage. In the examination of patients，pediatricians should pay more attention to the judgments of the position and movement of the coronary artery by CTA，and attach importance to the differential diagnosis between ischemic myocardial damage and myocarditis.

Key words: anomalous origin of coronary artery, ischemic myocardial damage, myocarditis, differential diagnosis, treatment

摘要：

目的　探讨冠状动脉起源异常合并心肌损害的临床特点及相应治疗策略，提高临床医师对此类疾病的认识和诊治水平。方法　回顾性分析2015—2017年首都医科大学附属北京儿童医院心脏内科诊治的72例冠状动脉起源异常合并心肌损害患儿的临床资料，总结其临床特点和诊疗方法。结果　本组42例（58.3%）患儿以胸痛、胸闷、心悸为主要临床表现，心电图异常以ST-T改变（62.5%）为主，超声心动图结果示13例（18.1%）患儿合并心脏扩大，4例（5.6%）合并左室收缩功能减低。冠状动脉CT血管造影检查（CTA）结果示左冠状动脉起源异常最为常见（73.6%），其次为双侧冠状动脉起源异常（13.9%），单纯右冠状动脉起源异常最少见（12.5%）。所有患儿诊治过程顺利，无死亡病例。结论　冠状动脉起源异常可导致不同程度心肌供血问题，引起缺血性心肌损害，在患者的检查中更应重视CTA对冠状动脉开口位置和走行的判断，在诊断治疗中更应注意其与儿童心肌炎的鉴别。

关键词: 冠状动脉起源异常, 缺血性心肌损害, 心肌炎, 鉴别诊断, 治疗