Koroner arter köken ve seyir anomalileri

Özet

Koroner köken ve seyir anomalileri, bir damarın olağan aort sinüsünden çıkmaması veya başlangıçtan itibaren farklı bir rota izlemesiyle oluşan konjenital anatomik farklılıklardır. Karşı sinüsten çıkan damarda interarteriyel ya da aort duvarı içi segment, dar yarık biçimli ostium ve keskin çıkış açısı özellikle dikkatle tarif edilir. EKG eşzamanlı koroner BT anjiyografi, ostiumu ve proksimal damarı aort ile pulmoner arter ilişkisi içinde yüksek uzaysal çözünürlükle gösterir. Anormal başlangıç veya risk taşıyan proksimal segment gözden kaçarsa klinik olarak önemli koroner anatomi raporlanmayabilir.

Faz ve pencere

BTA tanısal

EKG eşzamanlı ince kesit koroner BT anjiyografide aort kökü ve pulmoner trunkusun yeterli opasifikasyonunu kullanarak her ostiumdan proksimal koroner yatağa ilerle. Ostiumun sinüsünü, çıkış açısını, aort duvarı içindeki segmenti ve damarın büyük damarların önünden, arasından ya da arkasından geçtiği rotayı merkez hat ve oblik rekonstrüksiyonlarda belirle.

Önerilen pencereler: Anjiyo (G 600 / M 150), Mediasten (G 350 / M 50).

BT bulguları

• Ostiumun kökeni — sağ, sol veya nonkoroner sinüs; karşı sinüs, yüksek aort ya da pulmoner arter çıkışını adlandır.
• Ostium biçimi ve çıkış açısı — yarık görünüm, dar giriş veya aort duvarına teğet başlangıcı koronal-oblik ve kısa eksen kesitlerinde incele.
• İnterarteriyel rota — başlangıç segmentinin aorta ile pulmoner trunkus arasındaki koridordan geçtiğini damar boyunca doğrula.
• İntramural segment — koroner lümenin bir bölümünün aort duvarı içinde ve aort lümenine komşu seyrettiğini göster.
• Retroaortik rota — damar aort kökünün arkasından dolaşıp karşı tarafın koroner dağılımına yönelir.
• Prepulmonik rota — koroner dal pulmoner trunkusun önünden kalbin ön yüzüne doğru geçer.
• Transseptal/subpulmonik rota — damar miyokard içinden, septum boyunca veya pulmoner kökün altından seyreder.
• Retrokardiyak rota — anormal koroner dal aort kökünün arkasından geçer; bu anatomik varyant güncel sınıflamalarda retroaortik rota olarak adlandırılır ve genellikle hemodinamik önemi yoktur.
• Proksimal lümen biçimi — eliptikleşme ya da odaksal daralma varsa damarı merkez hattına dik kısa eksen kesitlerinde doğrula.

Ölçütler ve sınıflamalar

Karşı sinüsten köken alan koroner arterin proksimal seyri

Tek bir evrensel sınıflama yoktur. Anormal kökenli koroner arterin proksimal seyri interarteriyel, prepulmonik, retroaortik veya transseptal olarak adlandırılır. Aort duvarı içindeki intramural segment ayrı bir anatomik özellik ve olası risk morfolojisi olarak ayrıca belirtilir.

Normalde

Normal başlangıçta sağ koroner arter sağ koroner sinüsten, sol ana koroner arter sol koroner sinüsten çıkar; proksimal segmentler aort duvarı içinde uzun bir rota izlemez. Kıyaslamada sinüsleri ve ostiumları tanımladıktan sonra her damarı merkez hattı boyunca takip et; böylece duvar içi bölüm ile damarların önünden, arasından veya arkasından geçen rotayı ayırabilirsin.

Ayırıcı tanı

Koroner arter fistülü

geniş veya kıvrımlı besleyici damar kalp boşluğuna ya da büyük damara sonlanır; anormal köken-seyir lezyonu değildir.

Miyokard köprüsü

ostium olağan sinüste kalırken epikardiyal arterin bir segmenti miyokard içinden geçer.

Sol ana koroner arter atrezisi, koroner arter anomalileri arasında yer alır.

Pulmoner arterden koroner çıkış

ostium aort sinüsü yerine pulmoner arter duvarından kaynaklanır.

Cerrahi reimplantasyon

koroner ağız doğumsal varyant gibi görünebilir; ameliyat hattı, greftler ve eski görüntüler kaynak yerini açıklar.

Tuzaklar

• Bir damarın tek kesitte aorta ile pulmoner arter arasında görünmesi rotayı kanıtlamaz; ostiumdan distal segmente kesintisiz merkez hat oluştur.
• Aort duvarı içindeki bölümle iki büyük damar arasındaki rota farklı özelliklerdir; aynı koroner arterde art arda bulunabileceklerini raporda ayrı yaz.
• Karşı sinüsten çıkan tüm arterler aynı anatomiye sahip değildir; pulmoner kök önü ve aort arkası rotalarını damarlar arası geçişle karıştırma.

Kendini dene

1. Bir yenidoğanda sol koroner sistemin pulmoner arterden kaynaklandığı görülüyor. Bu anatomik sendromun adı hangisidir?

   • Bland-White-Garland sendromu
   • ARCAPA sendromu
   • Wolff-Parkinson-White sendromu
   • Marfan sendromu
   Cevabı göster

   Bland-White-Garland sendromu. Sol koroner arterin pulmoner arterden çıkışı ALCAPA sendromu olarak bilinir ve tedavi edilmezse yaşamı tehdit eder. ARCAPA sağ koroner arterin pulmoner kökenden çıkışıdır; diğer seçenekler koroner köken anomalisi değildir.

2. Aort kökünden ortak tek ostiumla başlayan ve iki ana koroner dala ayrılan konjenital varyant nasıl adlandırılır?

   • Tek koroner arter
   • Koroner arter fistülü
   • Miyokard köprüsü
   • Koroner ostium atrezisi
   Cevabı göster

   Tek koroner arter. Tek aortik ostiumdan çıkan ortak koroner gövde, distal dallanma gösterse de tek koroner arter varyantıdır. Fistülde anormal boşalma bağlantısı, köprüde kas içi segment, atrezide ise lümen yokluğu veya kesintisi söz konusudur.

İlgili konular

• Anormal pulmoner venöz dönüş
• Atriyal septal defekt

Kaynaklar

Bu sayfadaki 42 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 5 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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