66例心肌梗塞的病理形态学分析

1954～1984年间我室收集的3771例尸检中的66例心肌梗塞(MI)。其中透壁性MI63例,心内膜下MI3例。冠状动脉(冠脉)Ⅲ级以上粥样硬化改变计118支,左前降支(LAD)占62支(52.5％),主旋支(LC)加右冠脉(RA)占56支(47.5％)。对应的前壁加前间隔MI31例(47％),后壁加侧壁MI28例(42.4％),左室巨大MI4例(6.1％)。并发症:心脏破裂12例(18.2％),室壁瘤7例(10.6％),乳头肌坏死8例(12.1％)及传导阻滞5例(7.0％)。提示MI首次发作、侧支代偿较差及冠脉新鲜血栓形成是诱发心脏破裂的危险因素。

A PATHOMORPHOLOGICAL ANALYSIS OF MYOCARDIAL INFARCTION WITH A REPORT OF 66 AUTOPSY GASES

This article reports 66 oases of myooardial infarction (MI). The necropsy material was collected from 3771 consecutive autopsy cases during a period of 30 years(1954-1984). The morphological features and complications of MI have been studied. Baroldi's histologioal criteria for staging MI was used, i. e., early, acute and recent stages. Among 66 cases of MI, 63 were transmural, 3 were subendocardial. 118 vessels with greater than 3rd degree atherosclerotic change of coronary artery were detected: LAD 62(52.5%), LC+RA 56(47.5%). Correspondant anterior and antero-septal MI 31 (47%), postero-lateral MI 28 (42.4%) and extensive LV MI 4(6.1%). Complications of MI were: cardiac rupture 12(18.1%), cardiac aneurysm 7(10.6%), necrosis of papillary muscles 8 (12%) and disturbances of the conduction system 5(7.0%). It is suggested that inadequate collateral circulation, a previous episode of acute myooardial infarction and fresh coronary thrombosis will be risk factors predisposing to acute cardiac rupture. Solerosing aortic stenosis, atherosclerotic plaques involving coronary orifices and endarterial thickening of intramural coronaries were coexistent findings in older patients, these enhanced further myocardial ischemia and rendered the patient's symptoms more complicated and atypical.