心肌桥和壁冠状动脉的形态及相关性研究

探讨心肌桥和壁冠状动脉的形态及相关性,为心血管病临床提供形态依据.方法:解剖100例正常人心脏的冠状动脉,取前室间支桥下段血管(壁冠状动脉)中份及出桥段血管起始部,作石蜡切片HE染色,在计算机图像分析仪下进行观测.结果:心肌桥出现率为85%,桥宽厚各为19.14±10.49mm,1.37±0.65mm.壁冠状动脉管径较其远端血管管径小;管壁较其远端血管壁薄;其形态有圆形、椭圆形、心形、不规则形和线形.相关分析表明;心肌桥的宽度与壁冠状动脉管径呈负相关;桥的宽度和厚度与其远端血管管径呈正相关;桥的厚度与壁冠状动脉内膜呈负相关.     

家猪壁冠状动脉观测及与犬壁冠状动脉比较

目的为壁冠状动脉比较解剖学积累资料，为选择动物模型提供依据。方法家猪心脏塑化染料灌注，10％甲醛溶液固定，大体解剖显示壁冠状动脉，测量数据，并与既往文献报道的犬的壁冠状动脉分析比较。结果家猪壁冠状动脉出现率为50．0％，前室间支、后室间支壁冠状动脉出现率为15．0％、27．5％。前室间支壁冠状动脉近端径（1．96±0．71）mm，远端径（1．52±0．80）mm，长度（9．19±6．58）mm。总壁冠状动脉长度（9．20±4．99）mm。一支血管上可出现1-2处的壁冠状动脉壁。壁冠状动脉可以扭曲和发出细小的分支血管。结论家猪可以作为动物模型研究壁冠状动脉，但犬比家猪更为适合。     

狗心肌桥及其显微结构

为心肌桥比较解剖学积累资料，并为研究心肌桥选择实验动物提供依据，本文选用成年狗１２０条，对其心肌桥进行大体解剖测量和显微结果观察。结果如下：心肌桥出现率６０．８％；心肌桥多位于左冠状动脉前室间支，占肌桥数的７３．３％；心肌桥宽７．６±５．１ｍｍ；厚０．４±０．２ｍｍ；肌桥与冠状动脉夹角８５．４±２４．５°；肌桥细胞纤维排列紧密、较直、无分支。结果提示：狗心肌桥出现率、部位等与人相似，可做为研究心肌桥的实验动物。     

山羊肺静脉心肌袖解剖学观测

目的观察山羊肺静脉心肌袖的形态特征,为异位房颤动物模型提供形态资料。方法解剖30例山羊肺静脉,充分暴露心肌袖,进行形态学观测。结果30例羊心均出现肺静脉心肌袖,其中斜形47.6%,环形40.9%,纵形11.5%。右上、右下、左下、左上肌袖厚度分别为0.46±0.14mm、0.35±0.16mm、0.35±0.11mm、0.37±0.13mm,长度分别为10.75±3.15mm、9.46±2.20mm、11.41±2.87mm、9.20±2.88mm。结论30例山羊肺静脉心肌袖出现率为100%,可能与局灶性房颤的发生有关。     

多排螺旋CT对冠状动脉心肌桥的诊断及对壁冠状动脉平均长度、平均埋藏深度、平均狭窄程度的临床分析

目的:探析多排螺旋CT对冠状动脉心肌桥的诊断价值及对壁冠状动脉平均长度、埋藏深度、狭窄程度的评估价值.方法:选取2020年8月至2021年8月期间至我院接受多排螺旋CT冠状动脉造影检查的疑似冠心病患者200例作为研究对象,200例患者均统一实施冠脉造影以及64排256层螺旋CT检查.比较不同检查方式下冠心病及冠状动脉心肌桥的检出率,患者壁冠状动脉的平均长度、平均埋藏深度、平均狭窄程度及具体发病位置,并对比不同检查方式患者不良反应发生情况.结果:冠脉造影结果显示200例疑似冠心病患者检出率为70.50％(141/200),76例心肌桥-壁冠状动脉患者包含122处发病位置,壁冠状动脉平均长度为(5.31±2.12)mm、平均埋藏深度为(2.41±1.15)mm、平均狭窄程度为(43.15±10.58)％.螺旋CT结果显示200例疑似冠心病患者检出率为86.50％(173/200),102例出现心肌桥-壁冠状动脉患者包含215处发病位置,壁冠状动脉平均长度为(6.75±2.28)mm、平均埋藏深度为(3.17±1.45)mm、平均狭窄程度为(48.26±10.35)％;冠脉造影下患者不良反应发生率23.00％(46/200)高于多排螺旋CT10.50％(21/200),差异均具有统计学意义(P<0.05).结论:采用多排螺旋CT可准确诊断冠状动脉心肌桥并明确其具体发病位置,具有较高的临床应用价值.     

左冠状动脉分支异常伴肺动脉四瓣变异

在解剖实验教学中，发现心左冠状动脉旋支直接始发于左心室并伴有肺动脉4个瓣膜的变异心脏标本，该变异实属罕见。男尸，约50岁，心脏大小正常。左冠状动脉旋支直接起始于左心室前壁上部，走行于心左缘，绕过心尖后方，与前室间支吻合。其起始处，距主动脉根部30．5mm，距右房室口后瓣基底部10．2     

家猪心壁冠状动脉观测及与人心壁冠状动脉的比较

目的探讨家猪心壁冠状动脉解剖学特征,为制备实验动物模型提供依据。方法40例家猪心塑化染料灌注,显示左、右冠状动脉及分支走行。10%甲醛溶液固定,大体解剖,暴露壁冠状动脉及其分支,观察并统计数据。结果40例猪心壁冠状动脉出现20例(50.0%);前室间支、后室间支出现壁冠状动脉的心分别有6例(15.0%)、11例(27.5%);壁冠状动脉在心肌桥下可发出1～4个分支,5例壁冠状动脉出现扭曲现象。结论猪心壁冠状动脉出现率及形态学结构与人相似,适合作为研究人心壁冠状动脉的动物模型。     

狗,羊,猪,兔冠状动脉心肌桥的解剖学研究

为心肌桥比较前解剖学积累资料，并为研究心肌桥选择动物提供依据。方法；选用成年狗，羊，猪，兔心脏观察测量。结果；兔冠状动脉全程位于心肌内。狗，羊，猪心肌桥出现率分别为６０．８％，９０．１％和４２．４％。狗，羊心肌桥位于左冠冠状动脉者占各自肌桥数的８７．８％和９５．６％。狗心肌桥位于前室间支为７３．３％；羊心肌桥地左冠状动脉主干占４８．２％。     

胰,胆总管插管的应用解剖

在30例成人的标本上,对十二指肠第1环状襞、十二指肠纵襞、十二指肠大乳头、肝胰壶腹及其间隔等进行解剖观测.十二指肠第1环状襞高4.86±0.36mm,厚2.85±0.17 mm,距幽门45.80±2.93mm;十二指肠纵襞出现率为76.7%;十二指肠大乳头距幽门、第1环状襞的距离分别为81.14±2.71和41.76±2.11mm,其开口处上下径和横径分别为2.88±0.17mm和2.31±0.19mm.在20例肝胰壶腹切开的标本上见肝胰壶腹间隔部分分隔(16例)和完全分隔(4例)胰胆管,间隔长度 9.30±0.46mm,共同管长度5.53±0.29mm.结果为临床内镜下顺利进行胰、胆总管造影术寻找十二指肠大乳头和插管提供了形态学依据.     

牙槽孔及其毗邻的解剖学研究及临床应用

目的:为上牙槽后神经阻滞麻醉提供解剖学资料。方法:对50具成人颅骨进行观测。根据观测结果弯制弧形注射针头,为50例患者进行上牙槽后神经阻滞麻醉。结果:牙槽孔距颧下嵴起始部距离,左侧(21.54±3.05)mm;右侧(20.91±2.50)mm。牙槽孔距颧下嵴起始部的弧长,左侧(20.91±2.50)mm。牙槽孔距颧下嵴起始部的弧长,左侧(23.28±1.64)mm;右侧(22.94±1.68)mm。结论:以牙槽孔至颧下嵴起始部的弧长和弦长为标准弯制注射针头,采用口内注射法进行上牙槽后神经阻滞麻醉,成功率为98％。     

The relationship of myocardial bridges to coronary artery dominance in the adult human heart

Myocardial bridging is recognized as an anatomical variation of the human coronary circulation in which an epicardial artery lies in the myocardium for part of its course. Thus, the vessel is 'bridged' by myocardium. The anterior interventricular branch of the left coronary artery has been reported as the most common site of myocardial bridges but other locations have been reported. The purpose of this study was to provide more definitive information on the vessels with myocardial bridges, the length and depth of the bridged segment, and the relationship between the presence of bridges and coronary dominance. Two hundred formalin-fixed human hearts were examined. Myocardial bridges were found in 69 (34.5%) of the hearts with a total of 81 bridges. One bridge was found in 59 of these hearts and multiple bridges were observed in ten (eight with double bridges and two with triple bridges). Bridges were most often found over the anterior interventricular artery (35 hearts). Bridges were also found over the diagonal branch of the left coronary artery (14), over the left marginal branch (five) and over the inferior interventricular branch of the left coronary artery (six). Bridges were also found over the right coronary artery (15 hearts), over the right marginal branch (four) and over the inferior interventricular branch of the right coronary artery (two). The presence of bridges appeared to be related to coronary dominance, especially in the left coronary circulation. Forty-six (66.6%) of the hearts with bridges were left dominant. Forty-two of these had bridges over the left coronary circulation and four over the right coronary circulation. Seventeen hearts (24.6%) were right dominant. Eleven of these had bridges over the right coronary circulation and six over the left coronary circulation. The remaining six hearts were co-dominant with four having bridges over the left coronary circulation and two over the right coronary circulation. The mean length of the bridges was 31 mm and the mean depth was 12 mm. The possible clinical implications of myocardial bridging may vary from protection against atherosclerosis to systolic vessel compression and resultant myocardial ischaemia.     

山羊心脏房间隔、室间隔的观测及解剖学特征

目的　观测山羊心脏房间隔、室间隔的形态及其位置关系,为心脏研究提供比较解剖学资料。方 法　用大体解剖法观测山羊房间隔的卵圆窝、室间隔膜部和肌部。结果　卵圆窝纵轴长9.63±2.18mm,横 轴长6.85±1.54mm,卵圆窝中心点距冠状窦口中心点9.09±2.10mm,距三尖瓣隔侧瓣中点12.81±2.34 mm,距二尖瓣前瓣中点8.94±2.65mm。卵圆窝上缘厚1.26±0.50mm,下缘厚1.80±0.40mm,前缘厚2.39 ±1.78mm,后缘厚2.29±0.89mm。室间隔膜前部宽2.94±1.13mm,中部宽4.66±1.15mm,后部长6.13 ±1.41mm,后部宽9.62±1.83mm,下缘长15.06±2.63mm。室间隔肌部上缘长37.63±4.48mm,前缘长 52.84±6.22mm,后缘长33.77±2.96mm,厚度9.34±1.69mm。结论　山羊心脏房间隔和室间隔与成人相 似,是心外科房间隔、室间隔修复的良好材料。     

壁冠状动脉与心肌桥的应用解剖学

本文在 50例心脏上测量了心肌桥位置的长、宽、厚度 ;并在光镜下观察了壁冠状动脉的结构。发现桥前段血管内膜较桥下、后段的内膜显著增厚 (P<0 .0 1) ,讨论了它与冠状动脉粥样硬化间的关系。     

壁冠状动脉血流动力学特性的实验模拟与理论研究

目的临床研究、动物实验和模拟试验都证实心肌桥在收缩期的压迫作用,可引起壁冠状动脉管腔狭窄,从而使流量、流速及压力发生变化,导致血流动力学特性的异常现象。作者从"水击"理沦的角度探讨冠状动脉心肌桥前端的压力和流速变化这一异常现象的力学背景。方法利用心肌桥模拟装置在收缩期中和舒张期初"水击"发生前后对壁冠状动脉血流动力学进行模拟并用一维水击波理论模型进行分析、计算,与正常情况下实验数据对比分析。结果壁冠状动脉近端收缩压的升高幅度、舒张期流速的升高幅度计算值与实验值基本一致。结论证实了壁冠状动脉血流动力学特性异常现象是由扰动引起的"水击"波。     

A very rare anatomic variation of the right ventricular branch: right ventricular descending branch from the anterior interventricular branch

The anterior interventricular branch of the left coronary artery has the most constant distribution in the human heart and rarely gives off right ventricular branches. Here we report a case with a right ventricular branch which diverged from the anterior interventricular branch and descended on the anterior right ventricular wall parallel to the anterior interventricular sulcus; we termed it the right ventricular descending branch. This artery gave a collateral artery to the occluded anterior interventricular branch at the apex, and had prevented anterior myocardial infarction. The right ventricular descending branch should be precisely identified in order to perform successful myocardial revascularization procedures such as coronary artery bypass grafting and percutaneous coronary intervention, especially in a patient with anterior interventricular branch occlusion.     

心肌桥的形态特点与冠状动脉粥样硬化关系

目的　探讨心肌桥（MB）存在及与冠状动脉粥样硬化（AS）的关系。 方法　回顾性分析在法医尸解中发现的87例心肌桥的形态特点与AS的关系。 结果　MB检出率34.7％,并随年龄呈阶梯样增加,心肌桥主要出现在左冠状动脉前降支及右主干, 单个MB最多,占90.8％（79例）。MB桥前段发生AS有43.7％（38例）,管腔狭窄程度大多在Ⅲ级以上占86.8％（33例）;桥后段有8％（7例）发生AS,管腔狭窄程度均在Ⅱ级以下,二者有统计学意义（P<0.05）,桥下段无AS;存在AS的MB长度大多2.0cm以上。 结论　大多数MB是解剖变异,随着年龄增加可导致桥前段和桥后段AS,桥前段更易发生AS。     

Pathomorphology and Pathogenic Role of Myocardial Bridges in Sudden Cardiac Death

Pathognomonic incidence of myocardial bridges during obstructive hypertrophic cardiomyopathy, hypertension, and ischemic heart disease was established. Myocardial bridges were predominantly found in the median segments of major coronary arteries with prevailence of bridge-like obstructions in the anterior interventricular branch of the left coronary artery. Typical changes in cardiac angioarchitectonics indicating pronounced inadequacy of coronary blood flow were determined depending on the segmentary directionality of bridge obstruction. The data attest to pronounced pathogenetic role of myocardial bridges in sudden cardiac death.     

Angiographic and surgical aspects of compressive muscular bridges and intramyocardial paths of the anterior interventricular artery (based on 12 cases)

The authors report 12 cases of myocardial bridges over the anterior interventricular artery discovered surgically. In 5 the compressive myocardial bridges were limited; in 7 the intramyocardial course of the anterior ventricular artery was discovered at operation. Comparison of the operative appearances with the angiographic findings affords a basis for anatomico-radiologic correlation. The authors stress the difference in frequency and significance between the compressive myocardial bridge (an indication for surgery) and the intramyocardial anterior interventricular artery discovered by chance during a procedure for coronary revascularization indicated for stenosing atherosclerotic lesions.