Coronary Artery Spasm

Coronary artery spasm is a transient reduction in lumen diameter of an epicardial coronary artery of sufficient degree to produce objective evidence of myocardial ischemia in the absence of any significant increase in heart rate or blood pressure. In this article are summarized pathophysiological observations, the coronary angiographic anatomy of patients with coronary spasm, etiologic considerations, methods to provoke coronary artery artery spasm and their clinical usefulness, the role of coronary artery spasm in patients with clinical angina pectoris and myocardial infarction, and finally, the role of coronary artery spasm in patients undergoing coronary artery surgery.     

Coronary Artery Perfusion

Perfusion of the coronary arteries with oxygenated blood during cardiopulmonary bypass should in theory offer perfect myocardial protection, but the difficulties sometimes encountered with direct cannulation and the hazards of prolonged fibrillation in spite of perfusion raise questions regarding its universal efficacy. Arguments for and against coronary artery perfusion are presented and the hazards of partial perfusion are stressed.     

Surgical Treatment of Coronary Artery-Pulmonary Artery Fistula with Coronary Artery Disease

Abstract   Coronary arteriovenous fistulae present rare clinical finding with the incidence of about 0.002% in the general population. Usually they are asymptomatic, but sometimes they can mimic other cardiac diseases, most commonly heart failure, myocardial ischemia, and endocarditis. Coronary arteriovenous fistulae have been reported to arise more commonly from the right coronary artery. Most of these fistulae are congenital, and only a small fraction acquired. In this report we present successful surgical treatment of coronary artery to pulmonary artery fistula combined with myocardial revascularization.     

冠心病合并甲状腺功能减退的冠状动脉旁路移植术

目的探讨冠心病(CAD)合并甲状腺功能减退患者施行冠状动脉旁路移植术(CABG)的临床效果。方法选择我科2002年9月至2009年6月,由同一位术者对21例冠心病合并甲状腺功能减退患者行CABG(甲减组),男6例,女15例;平均年龄60.4岁;其中体外循环下心脏不停跳手术3例,体外循环下心脏停跳手术1例,非体外循环心脏不停跳手术17例;术前均口服左旋甲状腺素,游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)明显改善后手术。选择同期20例甲状腺功能正常的CABG患者作为对照(对照组),男6例,女14例;平均年龄62.1岁。于术前、术中、术后观察两组患者甲状腺功能指标及临床预后指标。结果甲减组体外循环下手术患者死亡1例,术前有心包积液、心力衰竭,甲状腺激素水平低;其余20例生存者均为心脏不停跳手术,其中17例为非体外循环手术;术后随访2~30个月,左心室射血分数(LVEF)较术前增加(55%±21%vs.48%±17%)。对照组患者均生存。两组间术中心排血指数[2.7±1.4 L/(min.m2)vs.2.8±1.5 L/(min.m2),t=530,P=0.530]、住院时间(12.2±4.7 d vs.10.1±3.9 d,t=0.170,P=0.170)、呼吸机辅助呼吸时间(17.6±9.1 hvs.15.1±13.7 h,t=0.120,P=0.120)比较差异无统计学意义。围术期甲状腺激素水平检测显示,非体外循环下手术对激素水平影响较小。结论冠心病合并甲状腺功能减退患者,术前准备充分,采用心脏不停跳手术方式较为安全,围术期甲状腺素治疗是关键;对重度甲状腺功能减退患者在体外循环下手术风险大。     

Management of Traumatic Coronary Artery Injuries: Advantages of Off-Pump Coronary Artery Bypass

Coronary artery injuries are rare but highly lethal. Debate exists as to the best treatment for this complex set of injuries, with historical treatment favoring arterial ligation. Although conventional coronary artery bypass grafting using cardiopulmonary bypass has been used somewhat successfully, enthusiasm for off-pump CABG (OPCAB) has grown more recently. We report two unique cases of left anterior descending coronary arterial injuries managed successfully with OPCAB.     

Coronary Artery Bypass Following Percutaneous Transluminal Coronary Angioplasty

During a 4-year period, 286 patients underwent coronary artery bypass grafting (CABG) following percutaneous transluminal coronary angioplasty (PTCA). Seventy-three patients had single-vessel and 213 (74.5%) had multivessel coronary artery disease. Twenty-nine patients underwent PTCA because of an evolving acute myocardial infarction (MI). Forty-two patients had previously undergone 47 CABG procedures.One hundred fifteen patients underwent CABG on an emergency basis. Indications for emergency CABG after PTCA were prolonged chest pain (79.1%), worsening of coronary artery obstruction (59.1%), “current of injury” by electrocardiogram (31.3%), cardiogenic shock (27.8%), and, in a lesser incidence, ventricular fibrillation, coronary artery dissection (without obstruction), heart block, and intractable cardiac arrest. The 286 patients underwent 2.1 CABG procedures per patient with a thirty-day mortality of 6.3% (18 patients). The incidence of acute MI was 43.5 versus 4.1%; low cardiac output syndrome, 34.8 versus 7.0%; and operative death, 11.3 versus 2.9% in the emergency and nonemergency groups, respectively. Other significant predictors of operative death were previous CABG (16.7 versus 4.5%), multivessel coronary artery disease (8.0 versus 1.4%), and preoperative cardiogenic shock (15.6 versus 3.2%). Late follow-up reveals a mortality of 1.4% per year in those patients who were early survivors of CABG.     

老年冠心病患者经桡动脉与股动脉行冠状动脉造影效果比较

目的 比较经桡动脉与股动脉穿刺行冠状动脉造影患者术后护理的优缺点,为针对性护理提供依据.方法 119例老年冠心病患者中57例经桡动脉途径置管(桡动脉组)、62例经股动脉途径置管(股动脉组),比较两组一次置管成功率、肢体制动时间、术后患者主诉、并发症发生率及住院时间.结果 肢体制动时间、患者主诉、局部血肿发生率及住院时间,桡动脉组显著优于股动脉组(均P＜0.01);两组一次置管成功率比较,差异无显著性意义(P＞0.05).结论 经桡动脉与股动脉穿刺均安全、有效、可行;桡动脉组术后治疗性损害相对较轻,更适合老年患者.     

老年冠心病患者经桡动脉与股动脉行冠状动脉造影效果比较

目的 比较经桡动脉与股动脉穿刺行冠状动脉造影患者术后护理的优缺点，为针对性护理提供依据。方法 119例老年冠心病患者中57例经桡动脉途径置管（桡动脉组）、62例经股动脉途径置管（股动脉组），比较两组一次置管成功率、肢体制动时间、术后患者主诉、并发症发生率及住院时间。结果 肢体制动时间、患者主诉、局部血肿发生率及住院时间，桡动脉组显著优于股动脉组（均P〈0．01）；两组一次置管成功率比较。差异无显著性意义（P〉0．05）。结论 经桡动脉与股动脉穿刺均安全、有效、可行；桡动脉组术后治疗性损害相对较轻，更适合老年患者。