463例心脏瓣膜病冠状动脉造影分析

目的　观察心脏瓣膜病患者的冠状动脉病变的发生率。方法　对 46 3例心脏瓣膜病患者术前临床资料和选择性冠状动脉造影的结果进行综合分析。结果　心脏瓣膜病并发冠状动脉病变发生率为 16 8% ,其中无症状占 88 3%。结论　年龄大于 5 0岁者 (有冠心病危险因素者提前到 45岁 ) ,心脏瓣膜置换术前应常规行选择性冠状动脉造影检查 ,以减少手术并发症 ,确保瓣膜置换术后复跳成功     

173例退行性心脏瓣膜病冠状动脉造影结果分析

目的:探讨退行性心脏瓣膜病患者合并冠心病的高危因素,探寻提高退行性心脏瓣膜病围术期冠状动脉(冠脉)造影选择性的方法。方法:回顾性分析2013-01-2017-06我院173例退行性心脏瓣膜病手术患者的临床资料,术前均行冠脉造影(CAG)检查。按是否同期诊断冠脉病变分为冠脉病变组和无冠脉病变组,比较两组患者的临床资料,采用单因素和多因素Logistic回归分析退行性心脏瓣膜病合并冠脉病变的危险因素及临床疗效的差别。结果:CAG结果显示,39例合并冠心病,发生率为22.5%,其中24例同期行冠脉旁路移植术。统计分析表明冠脉病变发生与心脏瓣膜疾病类型之间无明显关联(χ~2=4.045,P=0.132);而年龄≥55岁(OR=4.779,P=0.001)、有典型胸痛症状(OR=102.218,P=0.001)、合并糖尿病(OR=7.436,P=0.016)则是退行性心脏瓣膜病患者合并冠脉病变的独立危险因素。结论:对于年龄≥55岁、有典型胸痛和合并糖尿病的退行性心脏瓣膜病患者术前行CAG检查具有明确的指征。     

成年人心脏瓣膜冠状动脉造影41例分析

1998年 1 1月～ 2 0 0 0年 1 1月 ,我院对 41例年龄≥ 40岁拟行心脏瓣膜置换术的心脏瓣膜病患者 ,术前常规行选择性冠状动脉造影检查及有关实验室检查 ,以了解心脏瓣膜病合并冠状动脉粥样硬化的发生率及相关因素。现报告如下。1　资料与方法1 .1　一般资料　本组 41例患者中 ,男 1 8例 ,女 2 3例。年龄 40～ 67岁。40～ 49岁 7例 ,5 0～ 5 9岁 2 3例 ,60～ 69岁 1 1例。病程 1 .5个月～ 40年。心功能分级 : 级 3例 , 级 2例 , 级 35例 , 级 1例。心脏 B超(惠普 2 5 0 0 )检查 :左房内径 5 .72± 0 .97cm,左室内径 5 .43± 1 .1 9cm;单纯二…     

150例心脏瓣膜病冠脉造影分析

目的观察心脏瓣膜疾病患者合并冠状动脉病变的发病情况。方法对150例心脏瓣膜病的患者术前临床资料和冠脉造影的结果进行综和分析。结果150例患者中冠脉造影有15例诊断为冠心病,瓣膜退行性病变合并冠心病的发病率显著高于非瓣膜退行性病变组（P〈0.01）,颈动脉超声是术前冠脉造影的良好预测指标。结论瓣膜退行性病变合并冠心病的发病率大于非瓣膜退行性病合并冠心病的发病率。颈动脉超声能较好地预测冠心病的发病,是一个较好的术前检查指标。     

196例瓣膜病颈动脉造影结果分析

重度的颈动脉狭窄是心脏手术如瓣膜置换术、冠状动脉旁路移植术围手术期发生脑卒中并发症的不可忽视的原因之一。瓣膜病合并冠心病的伴发率约为12％，目前国内尚未见瓣膜病合并颈动脉狭窄伴发情况的有关报道。     

106例冠状动脉造影分析

冠状动脉造影 (ＣＡＧ)是显示冠状动脉病变部位及狭窄程度的重要方法 ,对临床冠心病、心绞痛及心律失常等的诊断及治疗有重大意义。现将我院自 1997年 6月至2 0 0 2年 6月资料完整的 10 6例ＣＡＧ报告如下。1　资料与方法1.1　一般资料 :本组 10 6例中 ,男 84例 ,女 2 2例 ,年龄 19～ 81岁 ,平均 5 8.0± 8.2岁。其中心肌梗死组 2 1例 ,典型心绞痛组 3 8例 ,不典型心绞痛组 2 2例 ,其他组 2 5例 (主要包括心律失常 16例、心瓣膜病 5例及病因不明心衰患者 4例 )。1.2　方法　以常规ｓｅｌｄｉｎｇｅｒ法行股动脉穿刺成功后 ,运用ｊｕｄｋｉｎ…     

冠状动脉旁路移植术同期心脏瓣膜术治疗心脏瓣膜病的临床观察

目的探讨冠状动脉旁路移植术同期心脏瓣膜手术的临床治疗效果。方法选取2011年1月2013年1月冠状动脉旁路移植术同期心脏瓣膜手术患者20例,对其临床资料进行回顾性分析。结果术后早期死亡3例,死亡率为15．0％,其中1例患者因左室破裂死亡,1例因多器官功能衰竭死亡,1例因呛咳导致室颤死亡。对余下17例患者手术治疗,随访3个月～18个月,患者心功能得到有效改善,无严重心绞痛发生。结论风湿性瓣膜病患者,且存在冠心病高危因素,则应进行冠状动脉造影检查,缺血性二尖瓣关闭不全的患者,如果瓣膜成形效果不显著,则应保留瓣下结构的瓣膜置换。     

冠状动脉粥样硬化合并心脏瓣膜病临床治疗观察

【】目的探讨心脏瓣膜病患者合并有冠状动脉粥样硬化的患者,在行瓣膜置换的同时行冠状动脉搭桥,并对手术方法及临床治疗效果等临床资料进行总结分析.     

20例冠状动脉造影与心脏螺旋CT结果分析

目的：探讨心脏螺旋CT冠状动脉钙化(CAC)在冠心病诊断的临床价值。方法：选择20例在我院治疗并行螺旋CT扫描及冠状动脉造影的冠心病病人，对其结果进行分析。结果：螺旋CT平扫发现冠状动脉钙化诊断冠心病的敏感性为79％，特异性为65％，准确性为75％。结论：心脏螺旋CT冠状动脉钙化(CAC)在冠心病诊断中具有一定的临床价值。     

1264例选择性冠状动脉造影的分析

我院１２６４例（男９７６例，女２８８例）选择性冠状动脉造影结果显示：冠状动脉造影确诊冠心病（ＣＡＤ）５６１例，阳性率４４．４％，其中男性４８５例，占男性人数的５０％，女性７６例，占女性人数的２６％。血管受累依次为前降支、三支血管病变（二支血管病变加左主干病变包括在内），二支血管病变，单支右冠，单支回旋支。冠状动脉造影还应用于非冠心病心脏手术前，如瓣膜病、夹层动脉瘤、先天性心脏病疑有冠脉异常者，以及发现冠脉发育或走行异常等。     

成年人瓣膜病合并冠心病的伴发情况分析

为了评估成年人瓣膜病变患者的冠心病伴发率。我们对本院自１９８８年６月至１９９５年１２月４０岁以上５５０例瓣膜病者的冠状动脉造影进行回顾性研究。男３４３例，女２０７例。年龄４０￣７２岁，平均５４．３岁。二尖瓣、主动脉瓣和联合瓣膜损害分别为２０５例。１０７例，２３８例。１５６例心电图呈ＳＴ－Ｔ改变，１１６例有心绞痛症状。结果：５５０例中７６例冠状动状有单支或多支≥５０％的狭窄病变，占１３．８％，就年龄     

Report: Association of coronary artery disease and valvular heart disease in chile

This study analyzes the prevalence of coronary artery disease (CAD) among patients with rheumatic valvular heart disease (VHD) in Chile. Coronary angiography was performed in all patients referred to cardiac catheterization with VHD who were over age 50 years and who had angina or ECG signs of ischemia. A total of 100 patients entered the study. Significant CAD (greater than 50% obstruction) was found in 14% of the cases: 7% in patients with mitral valve disease (MVD), 18% in aortic valve disease (AVD), and 21% in combined mitral and aortic valve disease (MAVD). Angina was present in 14% of the patients with MVD, 63% with AVD, and 53% with MAVD. Only 57% of patients with CAD had angina pectoris; 20% with angina had CAD. Hemodynamic parameters and left ventricular ejection fraction were not correlated with the presence or absence of CAD. We conclude that in patients with valvular heart disease, the incidence of CAD is lower in Chile than previously reported in the English literature. We confirmed the fact that angina is often not associated with CAD, and that CAD is often present in the absence of angina.     

Angina, coronary risk factors and coronary artery disease in patients with valvular disease. A prospective study

The relationship between coronary risk factors and coronaryartery disease in patients with valvular heart disease was studiedprospectively in 387 consecutive patients undergoing routinecoronary arteriography prior to valve replacement. Coronary artery disease was as common in patients with mitralvalve disease (31.9%) as in those with aortic valve disease(26.8%) Although it occurs more frequently in patients withangina (45.7%) significant coronary artery disease is foundin 19.2% (47 of 245) of those without angina (P<0.001), suggestingthat the presence of angina alone is an unreliable indicatorof significant coronary disease. The prevalence and severityof significant coronary artery disease increases progressivelyas the number of coronary risk factors also increase (P<0.001)but the prevalence is low (3%) in patients in whom both anginaand coronary risk factors are absent. These findings suggestthat preoperative coronary arteriography might be omitted inthis latter group of patients.     

培哚普利和坎地沙坦倍增剂量治疗老年退行性心脏瓣膜病心力衰竭疗效观察

目的评估培哚普利和坎地沙坦倍增剂量对老年退行性心脏瓣膜病心力衰竭的疗效。方法 218例老年退行性心脏瓣膜病心力衰竭患者随机分为3组:培哚普利组(4mg/d治疗2周后改用8mg/d)、坎地沙坦组(4mg/d治疗2周后改用8mg/d)、对照组(常规抗心力衰竭治疗,不用血管紧张素转换酶抑制剂),治疗24周,观察患者治疗前后坐位血压、血清高敏C反应蛋白(hsCRP)、脑钠肽、左室质量指数(LVMI)的变化,并记录治疗期间的不良反应。结果培哚普利组治疗后LVMI、血清脑钠肽、hsCRP均明显下降(P0.05);坎地沙坦组血清LVMI、脑钠肽亦出现下降,但无统计学意义,而血清hsCRP则显著降低(P0.05);3组抗心力衰竭治疗的有效率分别为:培哚普利组84.9%,坎地沙坦组69.3%,对照组52.0%,3组间差异有统计学意义(P0.05)。培哚普利组不良反应发生率最高(15.1%),其中咳嗽副反应发生率为6.5%,而双下肢水肿发生率对照组明显高于治疗组(P0.05)。结论培哚普利和坎地沙坦倍增剂量治疗均能减轻左室肥厚,对于老年退行性心脏瓣膜病心力衰竭患者耐受性较好。     

老年退行性心脏瓣膜病心率变异的分析

目的　探讨老年退行性心脏瓣膜病 (SDHVD)患者心率变异性 (HRV)的改变。　方法　对SDHVD组5 1例 ,健康老年人组 5 0例进行HRV时域分析。　结果　与健康老年人比较 ,SDNN、SDANN ,RMSSD ,PNN5 0均显著降低 (P <0 0 5 )。　结论　HRV可作为评估SDHVD患者预后的手段。HRV降低的SDHVD患者易发生心脏事件 ,应及时检查并给予相应的防治措施     

洛伐他汀治疗老年退行陛心脏瓣膜病62例的疗效观察

目的研究洛伐他汀对老年退行性心脏瓣膜病（senile degenerative heart valvular disease,SDHVD）的治疗效果。方法选择2005年至2007年在阳江市人民医院住院并诊断为SDHVD的患者120例为研究对象,按电脑随机数字表法分为两组：治疗组（n=62）在基础治疗上加用洛伐他汀20mg／d睡前服用;对照组（n=58）接受基础治疗。平均随访24个月,记录主要血管事件（心力衰竭,急性冠脉综合征和死亡）的发生情况。结果120例中共有99例中至重度瓣膜疾病患者,不同类型重度瓣膜疾病患者中,纽约心脏协会心功能IV级患者的构成比明显高于同组心功能Ⅱ级和Ⅲ级。随访2年,两组共死亡26例,病死率达21．67％。治疗组有7例急性冠脉事件．发生率低于对照组的13例,差异有统计学意义[11．3％（7／62）vs.22．4％（13／58）,P〈0．05]。结论洛伐他汀能减少SDHVD的急性冠脉事件的发生率,患者预后好于对照组,可能与其稳定血管内斑块和抗炎的机制有关。     

Assessment of valvular heart disease by Doppler echocardiography

Doppler echocardiography provides direct hemodynamic data that are often complementary to those demonstrated by M-mode and two-dimensional echocardiographic imaging. This relatively new noninvasive technique has a number of important uses in patients with valvular heart disease. In both adults and children, Doppler measures of peak flow velocity through a stenotic valve allow accurate prediction of the pressure gradient across the valve, and the technique has particular promise for screening patients with suspected aortic or pulmonic stenosis. In patients with mitral stenosis but parasternal short-axis images of limited quality, Doppler velocity measures can provide novel data about the pressure gradient and mitral orifice area. Doppler techniques can also provide direct evidence for or against the presence of valvular regurgitation, and several approaches allow clinically useful estimation of the extent of aortic, mitral, or tricuspid regurgitation. In patients with known disease of one cardiac valve, Doppler is accurate for evaluating the integrity of a second valve. Finally, Doppler techniques have great promise for defining the nature, and perhaps the severity, of suspected prosthetic valve malfunction. Hence, we believe that Doppler echocardiography should become a routine part of the noninvasive evaluation of patients with known or suspected valvular heart disease.     

Congestive heart failure in valvular heart disease in pregnancies with and without valvular prostheses and anticoagulant therapy

The course and complications of pregnancies in 46 patients with valvular disease and congestive heart failure with or without valve prostheses are described. In group I consisting of 33 women without valve replacement and without anticoagulant therapy one thromboembolic event was seen, emergency closed or open heart surgery was necessary five times. One still-birth happened after open heart surgery. In group II, of 13 patients with prosthetic valve replacement and anticoagulation therapy there was no thromboembolism, but 2 spontaneous abortions and 2 premature stillbirths; 2 fetuses died after delivery, 3 had congenital abnormalities. Pregnancies in patients with valvular disease and congestive heart failure can be sustained relatively safely for the mother, even if emergency heart surgery becomes necessary. Heart surgery and anticoagulation treatment carry a higher risk for the fetus. Uterine blood loss is not increased, if coumadine treatment is switched to heparin administration shortly before delivery.     

Magnetic resonance imaging in valvular heart disease

Magnetic resonance techniques can be employed to depict valvular abnormalities but are especially helpful in quantifying regurgitant or stenotic lesions which cannot be quantitatively assessed by other noninvasive techniques. Gradient echo techniques and phase velocity mapping are the most important magnetic resonance pulse sequences employed for these purposes. Valvular regurgitation can be quantitated by measuring the area of signal void on conventional gradient-echo images, by calculating stroke volume differences from k-space segmented gradient echo images, by measuring the proximal convergence zone from velocity encoded images or by comparing stroke volumes of the ventricles from velocity measurements. In contrast to this variety of possibilities in regurgitant lesions, stenotic lesions can only be quantitated by using velocity mapping techniques. Magnetic resonance spectroscopy can be used to assess myocardial metabolism in chronic valvular lesions. However, this tool needs further development and more clinical data before its use can be recommended to assess the necessity and optimal timing of surgical intervention.     

冠心病合并2型糖尿病患者冠状动脉造影分析

目的:探讨冠心病合并2型糖尿病患者的临床特征和冠状动脉造影特点。方法:对110例冠心病合并糖尿病患者和40例冠心病不合并糖尿病患者进行临床和冠状脉造影资料的对比分析。结果:在冠心病合并糖尿病组中女性比例高(P<0.05),合并高血压(P<0.05)、高血脂者(P<0.01)比例高,冠状动脉造影发现多支病变的比例高(P<0.01)。结论:2型糖尿病患者常有多种心血管危险因素聚集,冠心病合并2型糖尿病者多支病变常见。