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首页> 外文期刊>Texas Heart Institute journal / >Low Origin of the Coronary Arteries and a Small Aortic Annulus Complicating Aortic Valve Replacement
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Low Origin of the Coronary Arteries and a Small Aortic Annulus Complicating Aortic Valve Replacement

机译：冠状动脉起源低，主动脉瓣环小，主动脉瓣置换复杂

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摘要

Low origin of the coronary arteries, defined as an origin less than 10 mm above the functional aortic annulus, is not usually considered to be a notable anomaly because functional impairment is not intrinsic. We describe a case of severe complications after surgical aortic valve replacement in a 59-year-old woman who had symptomatic aortic valve stenosis, low origin of both main coronary arteries, and a hypoplastic aortic annulus less than 19 mm in diameter. The aortic prosthesis had to be implanted above the hypoplastic anatomic annulus. An inferior-wall myocardial infarction, hypotension, right-sided heart failure, and atrial fibrillation developed during the early perioperative period. Coronary angiograms showed occlusion of the right coronary artery ostium and critical stenosis of the left coronary ostium. During reoperation, posterior aortic patch annuloplasty enabled lower reimplantation of the prosthetic aortic valve, jointly with right coronary artery–venous grafting. To prevent potentially severe complications, we recommend that low origin of the coronary arteries be reported before patients undergo surgical aortic valve replacement. If the ostia are not seen when routine coronary angiography is used, computed tomography should be prospectively performed to characterize this anomaly.
机译：冠状动脉的低起点（定义为距功能性主动脉瓣环上方10 mm以下的起点）通常不被认为是明显的异常，因为功能损害并非固有的。我们描述了一位59岁的女性患者的手术主动脉瓣置换术后严重并发症的情况，该患者有症状性主动脉瓣狭窄，两个主要冠状动脉起源低以及增生的主动脉瓣环直径小于19毫米。主动脉假体必须植入在发育不良的解剖环上方。围手术期早期出现了下壁心肌梗塞，低血压，右侧心力衰竭和心房颤动。冠状动脉造影显示右冠状动脉口阻塞，左冠状动脉狭窄。再次手术期间，主动脉后部瓣膜瓣成形术与右冠状动脉-静脉移植术相结合，能够降低人工主动脉瓣的再植入。为防止可能发生的严重并发症，我们建议在患者进行外科主动脉瓣置换之前报告冠状动脉起源低。如果使用常规冠状动脉造影时未见到口，则应前瞻性地进行计算机断层扫描以表征这种异常。

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