~(99m）Tc－MIBI心肌灌注断层显像潘生丁试验对冠心病诊断及疗效观察的临床价值

对７０例９９ｍＴｃ－ＭＩＢＩ心肌灌注断层显像潘生丁试验（ＣＴＤ）及ＥＣＧ结果与冠状动脉造影（ＣＡ）进行对照分析，结果表明：ＣＴＤ检测冠状动脉管腔狭窄≥５０％病变的灵敏度和特异性分别是８８％和９３％，明显高于ＥＣＧ（５２％和７７％），检出左前降支（ＬＡＤ）、左回旋支（ＬＣＸ）及右冠状动脉（ＲＣＡ）病变的灵敏度分别为８２％、８４％及８３％；检测冠状动脉单支病变的灵敏度为８２％，检出轻、中、重度狭窄的灵敏度分别是４４％、８１％、１００％．对１７例经皮腔内冠状动脉成形术（ＰＴＣＡ）患者的术前术后ＣＴＤ结果进行了分析．结果表明ＣＴＤ对于诊断冠心病的灵敏度和特异性都很高，对筛选ＰＴＣＡ术前病人以及手术疗效评价和追踪观察有很重要的临床价值．     

304例选择性冠状动脉造影分析

本文报导我院自１９８４年４月￣１９９３年４月３０４例选择性冠状动脉造影Ｘ线表现。右冠优势型２５１例（８２．６％），左冠优势型２１例（６．９％），均衡型３２例（１０．５％）。经冠脉造影证实冠心病１６２例，冠脉累及３４１支，其中ＬＭ、ＬＡＤ、ＬＣＦ及ＲＣＡ分别为８支（２．２％），１３８支（４０．５％），８９支（２６．１％），１０６支（３１．１％）。左室造影显示左心射血分数ＬＶＥＦ与冠脉狭窄程度和室壁瘤     

PTCA后冠状动脉再狭窄的血管内支架治疗

目的：采用血管内支架经皮腔内冠状动脉成形术（ＰＴＣＡ）后冠状动脉再狭窄，利用运动试验来追踪评价其１年疗效。材料与方法：观察３２例ＰＴＣＡ成功病例，其中６例在术后１～８个月被诊断为再狭窄，选择Ｇｉａｎｔｕｒｃｏ－Ｒｏｕｂｉｎ型支架做再成形治疗，在术后第１、６、１２个月测定其运动试验结果，将所测定指标与单纯ＰＴＣＡ组病例做同期对照。结果：６例血管造影均为原部位的单支血管再狭窄，经支架成形处理后，狭窄度由９０．５％±３．４％（ｘ±ｓ）下降为１０．２％±６．７％；术后１年追踪运动试验表明，支架成形组较单纯ＰＴＣＡ组在运动耐量和运动时间方面占优势。结论：再狭窄的发生除了与血管内膜增生反应相关外，还与血管壁的慢性回缩和结构重塑相联系；血管内支架可对抗这一过程的发生，从而提高中远期疗效。     

经皮经腔冠状动脉成形术（附7例报告）

报告７例经皮经腔冠状动脉成形术（ＰＴＣＡ），其中单支病变４例（均为前降支局限性病变），多支病变３例。共扩张９支血管，除１例因病变僵硬伴钙化未能扩张，均获成功。术后１例短时间内又发生再狭窄（闭塞），其余心绞痛症状缓解或消失，ＥＣＧＳＴ－Ｔ波恢复正常，随访１年，病情稳定。     

争性下壁心肌梗塞心电图与冠脉造影对比分析

目的：通过１８导联心电图（ＥＣＧ）与选择性冠状动脉造影（ＣＡＧ）对比分析,寻找诊断右冠状动脉（ＲＣＡ）或左回旋支（Ｌｃｘ）闭塞的心电图特征。方法：３６例下壁心肌梗塞患进行１８导联ＥＣＧ与ＣＡＧ结果对比。结果：ＩＩＩＳＴ↑〉ＩＩＳＴ↑,ＲＣＡ闭塞组为２１例（８０．７％）;Ｌｃｘ闭塞组为０例（０％）,两有显差异,ａｖＬＳＴ↑〉ＩＳＴ↑,ＲＣＡ闭塞组２８例（８４．８％）,Ｌｃｘ闭塞组５例（１５．１％）,有显差异,Ｖ７～Ｖ９ＳＴ↑,ＲＣＡ闭塞组２组（２２．２％）;Ｌｃｘ组７例（７７．７％）,有显差异。Ｖ３Ｒ～Ｖ５ＲＳＴ↑,ＲＣＡ组为１２例（１００％）,Ｌｃｘ组０例（０％）,有显差异。结论：这些心电图特征在下壁心肌梗塞时有助于ＲＣＡ或Ｌｃｘ闭塞的临床诊断。     

经皮腔内冠状动脉成形术112例报告

经皮腔内冠状动脉成形术１１２例报告李敬邦江海寿孙立军贾国良张玉顺李保全经皮腔内冠状动脉成形术（ＰＴＣＡ）作为血管介入性治疗技术已成熟地应用于临床。我院自１９８５年９月至１９９４年１０月共完成ＰＴＣＡ１１２例，取得满意疗效。现将结果报告如下：资料和方法...     

冠状动脉内支架植入术(附20例报告)

目的：探讨冠状动脉内支架植入术（ＣＡＳＩ）在冠心病介入治疗中的价值。材料与方法：对２０例２１支病变血管植入２１个不同类型的支架进行分析。结果：植入成功率９５．２％（２０／２１）,病变狭窄度从８０％￣１００％降到２０％￣－１０％。在管腔扩张效果上,高压球囊优于低压球囊。未发生支架血栓及出血并发症。结论：ＣＡＳＩ可作为冠状动脉腔内成形术（ＰＴＣＡ）中急性闭塞和术后再狭窄的有效补救措施,而耐高压球囊的应     

经皮冠状动脉球囊成形术急性合并症的血管造影表现

作者总结近年１０６例经皮冠状动脉球囊成形术（ＰＴＣＡ）的急性合并症，如急性冠状动脉闭塞、血栓脱落引起远端栓塞、冠状动脉夹层及冠状动脉痉挛共１９例，对各种合并症的血管造影表现，尤其对ＰＴＣＡ所致冠状动脉夹层按不同类型进行分析后认为，正确认识合并症的血管造影表现，有助于选择治疗方法；冠状动脉造影的形态学表现，与ＰＴＣＡ急性合并症的可能性之间有密切相关性。     

经皮冠状动脉内球囊成形术后血管活性物质的变化

本文分析了２５例冠心病患者在ＰＴＣＡ前，ＰＴＣＡ后１ｄ，３ｄ和７ｄ的血浆ＥＴ、ＣＧＲＰ、ＳＰ和ＮＰＹ变化，发现ＥＴ由ＰＴＣＡ前的２１．４１±４．０１ｎｍｏｌ／Ｌ增加到ＰＴＣＡ后的４７．７６±１４３５ｎｍｏｌ／Ｌ，（Ｐ＜００１）在ＰＴＣＡ后３ｄ和７ｄ逐渐回降；ＣＧＲＰ由ＰＴＣＡ前的２．９５±１．２１ｎｍｏｌ／Ｌ增加到ＰＴＣＡ后的１７．９６±３．３４ｎｍｏｌ／Ｌ（Ｐ＜００１），在ＰＴＣＡ后３ｄ和７ｄ逐渐回降至术前水平；ＳＰ在ＰＴＣＡ后３ｄ和７ｄ明显降低；ＮＰＹ由ＰＴＣＡ前的１５２±０２７ｎｇ／Ｌ增加到ＰＴＣＡ后的３．４７±１２ｎｇ／Ｌ（Ｐ＜００１），在ＰＴＣＡ后３ｄ已回降至术前水平。认为ＰＴＣＡ术可以引起体内血管活性物质的变化，这些变化可能与ＰＴＣＡ并发证有关。     

数字减影血管造影在经皮冠状动脉腔内成形术中的应用（附10例报道）

作者采用ＤＳＡ对９２例冠状动脉硬化性心脏病施行冠状动脉（冠脉）造影，其中５２例（７１支）冠脉（ＣＡ）发现不同程度的狭窄；选择其中１０例ＣＡＳ患者行经冠脉腔内成形（ＰＴＣＡ），８例成功，狭窄管腔均获明显扩张（＞３０％），２例失败。文中着重讨论了ＤＳＡ在ＰＴＣＡ应用中的价值、限度与采取的措施。     

The behavior of collateral circulation after coronary artery bypass surgery

The changes in coronary collateral circulation after bypass surgery were analyzed in 50 patients with coronary disease. The demonstration of collateral circulation was found to be dependent upon the severity of the coronary heart disease and the patency of the bypass. When the graft was patent, it was usually not possible to visualize the collateral circulation demonstrated preoperatively. When the bypass was occluded, the same collateral circulation as before surgery was frequenctly found.     

Three-dimensional teaching model for coronary angiography

In order to improve the understanding and interpretation of cine coronary arteriograms obtained in various angled projections, a three-dimensional wire model was constructed. The main coronary arteries and most important muscular branches are simulated by a wire skeleton. The model can be rotated to simulate the standard right and left anterior oblique and left lateral projections. The degree of rotation is indicated on the base of the model. By tilting the model, cephalad and caudad tube angulation can be simulated. By placing the model in front of the cine projector, the shadows of the wires can be superimposed upon the projected cine coronary arteriogram. This simple, inexpensive model has greatly improved the three-dimensional understanding of the coronary arterial tree in various angled and nonangled views and in our practice had led to the development of additional useful projections.     

Coronary artery calcium screening: current status and recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging

Current guidelines and literature on screening for coronary artery calcium for cardiac risk assessment are reviewed for both general and special populations. It is shown that for both general and special populations a zero score excludes most clinically relevant coronary artery disease. The importance of standardization of coronary artery calcium measurements by multidetector CT is discussed. This consensus article is being published concurrently in the Springer Journal International Journal of Cardiovascular Imaging.     

Coronary venous anatomy and anomalies

Coronary venous anatomy can be divided into the greater cardiac venous system and the lesser cardiac venous system. With protocol optimization, including appropriate contrast bolus timing, coronary veins can be depicted with excellent detail on CT. Knowledge of variant coronary venous anatomy can sometimes play a role in pre-procedural planning. Analysis of the coronary venous anatomy on CT can detect coronary venous anomalies that cause right to left shunts with risk of stroke, left to right shunts, and arrhythmias.     

冠状动脉夹层(附14例报告)

目的：探讨冠状动脉夹层的造影表现、分型与临床预后的关系。材料和方法：１４例中男１３例、女１例。临床诊断冠心病，其中９例有心肌梗塞史。冠状动脉造影均显示内膜撕裂瓣片形成的线样透亮线；其中１２例为ＰＴＣＡ术后。结果：轻度内膜撕裂３例、平行夹层分离４例、局限型夹层分离５例、螺旋型分离２例。１４例中９例假腔内造影剂排空正常或轻度排空延迟，真腔无明显受压，病人无重要临床并发症。５例假腔造影剂排空延迟，真腔中－重度受压，其中３人出现急性心肌缺血和心肌梗塞体征。结论：结合临床预后冠状动脉夹层可分为真腔受压和真腔无明显受压两大类，后者一般不产生严重临床症状和体征；而前者可产生严重临床并发症，需要紧急治疗。     

电子束CT检测冠状动脉钙化的方法及初步结果报告

目的：报告电子束ＣＴ检测冠状动脉钙化（ＣＡＣ）的方法和初步研究结果。材料和方法：将经ＩｍａｔｒｏｎＣ－１５０电子束ＣＴ机检查冠状动脉的９０例分为三组：（１）非冠心组；（２）可疑组；（３）冠心组。对各例冠状动脉的走行进行观察；对比分析各组ＣＡＣ的发生率和钙化定量积分。结果：电子束ＣＴ能清晰地显示冠状动脉主干及主要分支。ＣＡＣ发生率冠心组为９５．０％（１９／２０例），可疑组为４８．６％（１７／３５例），非冠心组为２２．９％（８／３５例），差别具有显著性（ｐ＜０．００１）。发生ＣＡＣ的４４例中，冠心组的定量总分显著高于可疑组和非冠心组（Ｐ值分别＜０．０５和＜０．０１）。结论：电子束ＣＴ检测ＣＡＣ可为早期冠心病的诊断、预测和防治提供依据。     

334例选择性冠状动脉造影分析

目的:探讨冠心病病人冠状动脉病变范围、程度、评估冠脉造影价值及其局限性。方法:用Judkins法行选择性左、右冠脉造影334例,观察并记录冠脉病变范围和程度。结果:334例冠脉造影有病理性改变212例(63.4%),其中单支病变97例(45.7%),双支病变66例(31.1%)三支病变45例(21.2%),四支病变4例(1.9%)。共累及417支血管,分别为前降支207支(49.6%),右冠119支(28.5%),回旋支85支(20.3%)左主干6支(1.4%)。心肌梗塞组(A组)阳性率88.9%,心绞痛组(B组)80%,胸痛组(C组)11.7%。结论:选择性冠状动脉造影仍然是诊断冠心病的金标准,它具有其他无创性检查无法替代的作用。     

Unusual origin and course of the first septal branch of the left coronary artery: Angiographic recognition

The anatomical variants of the origin and course of the first septal branch (S1) of the left coronary artery system have received little attention in the literature dealing with coronary angiography. We describe here the angiographic features of the ectopic origin of S1 from epicardial branches of the left coronary artery other than the left anterior descending artery as observed in 8 cases from a series of 700 consecutive patients (1.1%). The S1 originated from the left main coronary artery in 1 case, from a diagonal branch in 4, and from an intermediate branch in 3 cases. Previous reported cases are reviewed. Because the S1 may supply up to 15% of the blood to the myocardium, the recognition of this variable origin may have clinical implications and has to be considered as a part of the complete evaluation of coronary arteriograms of patients referred for coronary artery revascularization.