单纯右冠状动脉狭窄对左心室功能的影响

目的:探讨单纯右冠状动脉（RCA）狭窄不同狭窄程度和狭窄节段对左心室功能的影响。方法:将冠状动脉造影证实为单纯RCA狭窄的患者99例,按不同狭窄程度、不同狭窄节段和不同冠脉优势型进行分组,并与494例无冠状动脉狭窄的对照组比较,经左心室造影测定的左室射血分数（LVEF）和左室舒张末压（LVEDP）。结果:与对照组患者相比,轻度、中度和重度单纯右RCA狭窄患者的LVEF变化不显著,完全闭塞患者的LVEF显著下降（P<0.05）;右冠中段、右冠远段、后降支和侧后支病变患者的LVEF均无有意义变化,右冠近段病变患者LVEF下降有统计学意义（P<0.05）。单纯RCA狭窄患者中,右冠优势组LVEF略低于均衡优势组和左冠优势组,但差异未达显著水平。单纯RCA狭窄对LVEDP的影响并不明显。结论:单纯RCA主干近段狭窄和单纯RCA完全闭塞对左室收缩功能可产生一定程度的损害。     

冠状动脉-锁骨下动脉窃血综合征一例

患者男,76岁。因＂胸闷13年,加重2个月＂于2013年12月17日入院。患者13年前间断出现活动时胸闷,伴气短,无胸痛。冠状动脉造影示：左主干（LM）末段狭窄60%,前降支（LAD）近段狭窄85%,回旋支（LCX）近段狭窄80%,右冠状动脉（RCA）中段狭窄80%。经冠状动脉旁路移植术治疗,分别行左乳内动脉（LIMA）至LAD吻合、     

52例急性下壁心肌梗死患者的冠状动脉造影特征

目的：探讨临床传统方法诊断为急性下壁心肌梗死（AIMI）患冠状动脉的特征。方法：对52例急性胸痛伴心电图Ⅱ，Ⅲ,aVF导联ST段抬高患行急诊冠状动脉造影，观察，分析相关血管的改变情况。结果：冠脉造影证实48例AIMI中相关病变血管为右冠脉（RCA）为37例（77．1％，37／48），其中闭塞为25例（占52．1％），左回旋支（LCX）病变20例（41．7％），其中闭塞10例（占20．8％），左前降支（LAD）不同程度狭窄6例（闭塞3例），左主干（LM）病变2例。4例冠脉造影无异常。结论：急性下壁心肌梗死相关病变血管主要为右冠状动脉和左冠状动脉回旋支。     

右冠状动脉病变对左冠状动脉狭窄患者左心室功能的影响

目的　探讨右冠状动脉病变对左冠状动脉狭窄患者左心室功能的影响及其机制。方法　对比分析左冠状动脉狭窄患者在合并与不合并右冠状动脉病变时的左心室射血分数。结果　与相应部位单纯左冠状动脉狭窄患者相比 ,合并右冠状动脉病变患者左心室射血分数均呈不同程度地下降 ,其中在左前降支、左前降支 +左回旋支狭窄基础上合并右冠状动脉病变时左心室射血分数下降有统计学意义 (P <0 .0 5或 0 .0 1) ,左主干合并右冠状动脉狭窄患者下降幅度最大 ,但无统计学意义。结论　右冠状动脉病变可在单纯左冠状动脉狭窄的基础上使左心室收缩功能进一步恶化 ;当左冠状动脉狭窄部位为左前降支、左主干或左前降支 +左回旋支时 ,对左心室收缩功能影响更为严重     

心电图正常的冠状动脉造影阳性病例分析

目的探讨心电图正常的冠心病病人冠状动脉造影特点.方法有典型的心前区疼痛病史而心电图正常的病人进行诊断性冠状动脉造影,收集冠状动脉造影阳性（冠状动脉狭窄直径≥50%）的完整冠心病病例共88例,其中合并有高血压病40例,糖尿病36例,进行分析.结果88例病人冠状动脉造影共累及病变数487处.其中左主干（LM）13例13处,左前降支（LAD）74例150处,左回旋支（LCX）59例106处,右冠状动脉（RCA）63例112处,对角支49例56处,间隔支1例1处,钝缘支15例15处,锐缘支4例4处,左室后支6例7处,后降支18例22处,中间支1例1处,左前降支心肌桥2例2处（其中1例心肌桥收缩期100%闭塞）;88例病人中100%闭塞病变18例（占20.5%）,存在侧支循环22例（占25%）;单支病变14例（占15.9%）,以左前降支为多,占78.6%（11/14）,双支病变28例（占31.8%）,左前降支＋右冠状动脉相对多,占46.4%（13/28）,三支病变33例（其中1例为LCX合并RCA及中间支）,占37.5%（33/88）,且多合并有高血压病及糖尿病.左主干病变13例,占14.8%（13/88）,其中左主干合并单支病变3例（占3.4%）,左主干合并双支病变4例（占4.5%）,左主干合并三支病变6例（占6.8%）.结论冠心病患者心电图正常的原因：病灶小、局限;病变狭窄程度轻;狭窄病变供血的心肌存在良好的侧支循环;冠状动脉存在广泛病变;心电图伪改善.因此,心电图与冠状动脉造影的不一致性提醒临床医师不应根据体表心电图无缺血改变而除外冠心病诊断.     

药物洗脱球囊在冠状动脉特殊病变介入治疗中的应用分析

目的分析药物洗脱球囊（DEB）在再狭窄病变、支架内闭塞病变、分叉病变及小血管病变中的应用情况。方法根据冠状动脉造影结果选择不同型号的DEB,严格按照DEB使用要求进行操作。结果 DEB在支架内再狭窄病变中应用26例（27处病变）,使用28个DEB,其中左主干（LM）1个、左前降支（LAD）12个、右冠状动脉（RCA）12个、回旋支（LCX）1个、钝缘支（OM）2个,出现1例冠状动脉夹层,给予裸金属支架置入;DEB在分叉病变中应用27例（28处病变）,使用28个DEB,其中LM至LCX开口6个、LM至LAD开口1个、LAD与第一对角支（D1）开口17个、LCX至OM 2个、RCA至左心室后支（PL）2个;DEB在小血管病变中应用13例（13处病变）,使用13个DEB,其中LCX 6个、LAD 3个、D1 2个、OM 1个、PL 1个;DEB在支架内闭塞病变中应用10例（10处病变）,使用12个DEB,其中LAD 8个、LCX 2个、OM 1个、中间支1个。术中及术后未见并发症发生,随访至今未发生主要不良心血管事件（MACE）。结论 DEB在再狭窄病变、支架内闭塞病变、分叉病变及小血管病变介入治疗过程中是安全的。     

冠状动脉旁路移植术后桥血管支架置入术2例

例1男,64岁,冠心病病史5年,1999年因3支弥漫病变及左主干(LM)病变行冠状动脉旁路移植术(CABG),术后第3天出现急性前壁心肌梗死,于2000年6月因频繁心绞痛入院。入院体检心肺无阳性体征,心电图符合前壁陈旧性心肌梗死(OMI)改变,超声心动图示前壁搏动减弱,符合前壁OMI改变,心功能正常。入院后行冠状动脉造影,结果示:左前降支(LAD)近端100%关闭,LAD远端与内乳动脉吻合口处90%狭窄,左回旋支(LCX)中远端70%狭窄,LM开口50%狭窄,右冠状动脉(RCA)中远端不规则病变,主动脉根部到RCA远端搭桥血管通畅。对前降支与内乳动脉吻合口狭窄处进行…     

老年冠心病合并糖尿病患者临床特点及冠状动脉病变特征分析

【摘要】 目的 探讨老年冠心病合并糖尿病患者临床特点及冠状动脉病变特征分析。方法 选取我院2012年3月至2015年2月经冠状动脉造影诊断为冠心病,且年龄>60岁的患者248例,根据是否合并糖尿病分为糖尿病组124例和非糖尿病组124例。统计患者基本临床资料及入院24h内实验室检查结果、超声心动图及心电图检查。根据冠状动脉狭窄直径≥50%累及左前降支（LAD）、左回旋支（LCX）、右冠状动脉（RCA）或左主干（LM）分为单支、双支（累及左主干为双支病变）及三支病变组。根据Gensini积分标准对每位患者冠状动脉病变进行评分。结果 冠心病合并糖尿病组空腹血糖（FPG）比非糖尿病组明显升高（P<0.001）。糖尿病组冠状动脉三支病变发生率高于非糖尿病组（P<0.001）,单支病变、两支/左主干病变发生率低于非糖尿病组（P<0.001）。与非糖尿病组相比,糖尿病组冠状动脉病变部位更多累及前降支、左回旋支和右冠状动脉,两组比较差异有统计学意义（P<0.05）。两组患者冠状动脉左主干病变并比较差异无统计学意义（P >0.05）。与非糖尿病组相比较,糖尿病组冠状动脉病变支数更多、Gensini积分更高（P<0.001）。结论 冠心病合并糖尿病患者冠状动脉病变更为广泛、严重,具有更高的致死风险。     

运动平板心电图阳性与冠脉造影价值的比较研究

目的分析无创性的运动平板心电图对冠心病的诊断价值。方法选择41例拟诊冠心病患者行运动平板心电图检查阳性,再行冠状动脉各分支造影后做对比分析及评价。结果运动平板实验对各病变血管的阳性预测性率,左前降支（LAD）为71.4%,左旋支（LCX）为54.3%,右冠状动脉（RCA）为60.0%,左主干（LM）为100%。运动平板对各病变血管的诊断准确性比较,左前降支（LAD）为72.6%,左旋支（LCX）为60.7%,右冠状动脉（RCA）为68.1%,左主干（LM）为2.8%。结论运动平板实验作为无创性检查冠心病方法,在不同部位血管支病变其诊断意义不同,应结合其他实验综合分析。     

经皮冠状动脉导丝回撤致右冠状动脉损伤、猝死一例

患女，70岁。2005年6月3日诊断为“急性下壁心肌梗死”，曾行溶栓治疗有效，无梗死后心绞痛。6月7日行冠状动脉造影示左前降支（LAD）弥漫不规则钙化，中段70％局限性狭窄；左旋支（LCX）多处迂曲呈直角弯，中段80％～90％狭窄；右冠状动脉（RCA）近、中段均有40％～50％弥漫病变和钙化、迂曲，远端后降支（PDA）分支处90％狭窄并延续至左室后支（PLV），累及PDA，PLV直径大于PDA。建议患行冠状动脉旁路移植术，但家属要求行经皮冠状动脉介入治疗（PCI）。故决定治疗RCA远段和LCX病变。     

The diameter of coronary artery is enlarged in patients with dilated cardiomyopathy

Background Dilated cardiomyopathy(DCM) is a primary cardiomyopathy characterized by the enlargement of left ventricle or biventricular and left ventricular systolic dysfunction, without any obvious stenosis of coronary arteries. However, it remains unclear that whether the diameter of coronary artery is different from those of normal population, because few studies directly assessed the diameter of the coronary artery in patients with DCM. The study aimed to evaluate the diameter of coronary arteries in DCM patients and its influence on prognosis for DCM patients. Methods Fifty-seven DCM patients and fifty-nine patients presenting with atypical chest pain and normal coronary angiography were enrolled in the study. A coronary angiography image analysis system was used to measure the diameters at 5 mm from the opening of the left main coronary artery(LM), left anterior descending(LAD) and left circumflex coronary(LCX) arteries, and the right coronary artery(RCA) of both groups. Follow-up study through telephone over a period of 2 years was performed. Spearman rank correlation and logistic regression were used to evaluate the correlations of the diameter of coronary arteries with the risk of nonfatal heart failure event. Results Diameters of the LM, LAD, LCX, and RCA in DCM group were significantly larger than those of the control group(P 0.001). During a follow-up of 2 years, the nonfatal heart failure event occurred in 9 patients of DCM group, but not in control group. Spearman rank correlation analysis showed diameters of the LM, LAD, and LCX were correlated with the risk of nonfatal heart failure event, respectively(P 0.05). While the diameter of RCA showed no correlation with the risk of nonfatal heart failure event(P =0.583). Whereas logistic regression analysis showed there were no correlation between diameters of the LM,LAD, LCX, and RCA and the risk of nonfatal heart failure event(P 0.05). Conclusions The coronary arteries of DCM patients show a larger diameter without any obvious stenosis, which may not correlate with the risk of heart failure event.     

冠心病伴束支传导阻滞患者冠状动脉病变特点研究

目的 :探讨冠心病伴束支传导阻滞患者冠状动脉血管病变特点。方法 :回顾性分析冠心病伴束支传导阻滞患者 (束支阻滞组 ,39例 )及无束支阻滞的冠心病患者 (对照组 ,35 1例 )心电图束支阻滞有无与冠状动脉病变的对应关系。结果 :与对照组比较 ,束支阻滞组左主干、左回旋支 (LCX)及三支血管 [左前降支 (LAD)、LCX、右冠状动脉 (RCA)同时存在病变 ]发生病变比率增加 (P <0 .0 1,P <0 .0 5 ,P <0 .0 5 )。右束支传导阻滞(RBBB)者LAD及RCA发病率高 ,RBBB并发左前分支阻滞 (LAFB)者三支血管病变发生率增高 ,左束支传导阻滞 (LBBB)者LAD、LCX病变发生率高 ,LAFB者LAD病变发生率高 ,房室传导阻滞伴束支阻滞患者多为三支血管病变。结论 :冠心病伴束支阻滞预示冠状动脉病变广泛而严重 ,LBBB提示冠状动脉血管病变以左冠状动脉为主 ,RBBB提示冠状动脉血管病变多累及RCA及LAD ,如存在 2种以上阻滞 ,特别是并发有左前分支或房室阻滞时 ,多提示存在三支血管病变及左主干病变     

A rare coronary anatomy comprising dual (Type IV) left anterior descending arteries and an anomalous left circumflex artery from the right coronary artery

We present the case of a rare coronary anomaly in a 64-year-old male who presented with exertional angina. The right coronary artery (RCA) was dominant, giving origin proximally to an anomalous left circumflex (LCX) artery and a left anterior descending (LAD) artery which supplied the conventional mid and distal LAD territory. The left main artery (LM) arose from the left coronary sinus and branched into a large first septal and an intermediate artery. There was associated non-critical atherosclerotic disease. We report this because of the rare division of the LAD area of supply by arteries from both coronary sinuses (dual LAD) with an anomalous LCX also arising from the proximal RCA. The clinical implications are discussed.     

Hypoplastic left coronary artery. In association with occlusive intimal thickening of a coronary artery with ectopic ostium and with atresia of the left coronary ostium

Two cases of hypoplastic coronary artery (HCA) are presented. Case 1, a 13 year old girl, died suddenly during a long distance race. She had HLCA with marked intimal thickening and an ectopic left coronary ostium above the commisure between the non-coronary and left coronary cusp at post mortem examination. The right coronary artery (RCA) was enlarged and also supplied parts of the area normally supplied by the left coronary artery (LCA). Pathological findings revealed a normal RCA and an extremely hypoplastic LCA with occlusive proliferation of the intima and a myocardial infarction of the left ventricle. Case 2, a 6 year old girl, had a history of effort angina. Selective coronary angiography was performed which failed to demonstrate the orifice of the LCA by aortography. However, the hypoplastic LCA was visualized by RCA angiography as a consequence of anomalous collaterals from the atrioventricular branch of the RCA. We postulate that HCA results from various conditions, including stenosis of the coronary artery orifice, an aberrant course between the pulmonary artery and aorta and ectopic positioning of the coronary artery ostium. In addition, HCA may also be associated with occlusive coronary artery abnormalities.     

Differential coronary artery calcification detected by electron beam computed tomography as an indicator of coronary stenosis among patients with stable angina pectoris.

BACKGROUND: The detection of coronary artery calcification by electron beam computed tomography (EBCT) has been suggested as an indicator of atherosclerosis and coronary artery disease (CAD). There is no consensus on the correlation between coronary calcification and angiographically significant stenosis on an artery-by-artery basis. OBJECTIVE: To examine the relationship between coronary calcification score (CCS) and the presence of significant CAD on an artery-by-artery basis in patients with stable angina pectoris. METHODS AND RESULTS: EBCT and coronary angiogram (CAG) were evaluated in 71 patients with stable angina and in nine control subjects. The CCSs of each of the four major coronary arteries were highest in patients with significant CAD (n=43), followed by patients with insignificant CAD (n=5), patients with syndrome X (n=23) and control subjects, respectively. Calcification scores of the four major coronary arteries appeared to have different predictive power for significant stenosis on the same vessel. For left main (LM) and left anterior descending (LAD) coronary arteries, CCSs of vessels with significant stenoses were not different from those without significant stenoses (values expressed as medians: LM 0 versus 1; LAD 98.5 versus 70; not significant). Calcification scores of left circumflex (LCX) and right coronary arteries (RCA) were significantly higher in vessels with significant stenosis (LCX 49.5 versus 0; RCA 53 versus 1; P<0.05). CCSs appeared to be moderately useful to predict significant stenoses in these two vessels (areas under receiver operating characteristic curves: LCX 0.68+/-0.08, 95% CI 0.52 to 0.81; RCA 0.71+/-0.08, 95% CI 0.55 to 0.84). CONCLUSIONS: The CCSs of RCA and LCX arteries, but not those of LM and LAD arteries, may predict significant angiographic stenosis on an artery-by-artery basis among patients with stable angina pectoris.     

冠状动脉管径与分叉角度的CT冠状动脉成像研究

目的 在冠状动脉CT图像上分析测量成人血管直径与血管分叉的生体信息,进一步加深对冠状动脉应用解剖的认识.方法 选择64排螺旋CT冠状动脉扫描图像质量优秀、血管完全正常的526例成人为观察对象,测量左主干及前降支、回旋支、右冠状动脉自开口至直径2 mm处每间隔1 cm处的管腔直径,计算管腔渐变率;测量大的对角支、钝缘支、锐缘支、后降支、左室后支(直径大于2 mm)开口直径,与同平面交角的主支血管直径和其上方1 cm处主干血管的直径以及分叉的角度.结果 前降支管径从开口的平均3.92 mm经过13 cm后移行为2.10 mm,呈逐渐变细的趋势,所有管腔的平均变化率为7.7％(男性7.0％,女性8.4％),管腔在距开口3 ～5 cm处变化率最大,达8.0％～10.0％;回旋支管径从开口平均的3.57 mm经过13 cm后移行为2.10 mm,呈逐渐变细的趋势,所有管腔的平均变化率为9.7％(男性9.6％,女性9.7％),开口至近端3 cm处管径变化率约3.0％,其后各点变化在8.3％～10.7％;右冠状动脉管径从开口平均的3.97 mm经过18 cm后移行为2.15 mm,呈逐渐变细的趋势,所有管腔的平均变化率为5.1％(男性4.9％,女性5.3％),开口至10 cm处管径变化率＜4.0％,其后变化率加大,在6.1％～15.2％之间.前降支与对角支、回旋支与钝缘支、右冠状动脉与后降支(左室后支)、右冠状动脉与锐缘支的夹角分别约为50°、55°、66°和76°.结论 64排螺旋CT冠状动脉成像可在生体上测量冠状动脉,获取三支主干血管的渐变率与最大渐变部位以及冠状动脉血管分叉的数据,进一步加深对冠状动脉应用解剖的认识.     

Congenital absence of the left circumflex coronary artery and an unusually dominant course of the right coronary artery

Congenital absence of the left circumflex artery (LCX) is a very rare congenital anomaly of the coronary circulation, and only a few cases have been reported in the literature. We report on a 55-year-old female with atypical chest pain. Routine coronary angiography showed a normal left anterior descending coronary artery (LAD), no LCX and a dominant right coronary artery (RCA), which continued beyond the crux, running the full course of the LCX and terminating in the left atrial branch. Neither aortography nor pulmonary angiography showed a separate ostium for the LCX. There were no atherosclerotic lesions in the coronary arteries, or ischaemia on stress myocardial perfusion imaging. Multidetector row computed tomography (MDCT) was performed to confirm the diagnosis.     

急性心肌梗死患者不同冠状动脉病变对介入术后预后的影响

目的探讨急性心肌梗死经皮冠状动脉介入治疗患者不同冠状动脉病变对预后的影响。方法将117例接受急诊经皮冠状动脉介入治疗的急性心肌梗死患者根据罪犯血管不同分为左前降支组51例、左回旋支组27例、右冠状动脉组39例。比较3组患者术后ST段回落〉70％的梗死相关导联数、TIMI血流分级、住院期间及出院后1年内主要心脏不良事件发生率。结果与左回旋支组和右冠状动脉组比较,左前降支组术后ST段完全回落的梗死相关导联数和左室射血分数显著降低（P〈0．05）,心源性死亡率及总主要心脏不良事件率显著升高（P〈0．05）。结论左前降支病变者术后心电图ST段回落更缓慢、左心功能不全更严重、主要心脏不良事件发生率更高、预后更差。