微创冠状动脉搭桥治疗多支冠脉病变临床效果与桥血管通畅率分析

目的 微创冠状动脉搭桥技术是治疗冠心病多支血管病变的新式方法,总结分析微创冠状动脉搭桥技术治疗多支冠脉病变的临床效果以及移植血管通畅率。方法 2016年12月至2017年4月,12例多支冠状动脉血管病变的患者于我科接受微创冠状动脉搭桥治疗,对患者围手术期资料与治疗结果进行分析,总结微创冠状动脉搭桥的治疗效果。结果 12例患者均顺利接受微创冠状动脉搭桥治疗,术中共完成远端吻合口26个。术中经左前外侧胸部小切口在直视下获取左侧乳内动脉与前降支搭桥,内窥镜获取下肢大隐静脉连接于升主动脉后与其他冠状动脉搭桥。无患者手术中转为开胸手术,术后呼吸机使用时间(7.6±4.2)ｈ,监护室停留时间(22.4±8.2)ｈ。10例患者未输血,占83.3％(10/12)。造影提示25/26 (96.2%) 个桥吻合口通畅。住院期间无死亡、心肌梗死、脑卒中等情况发生。结论 微创冠状动脉搭桥技术治疗多支冠脉病变安全有效,术后早期造影显示桥血管通畅率满意。     

冠状动脉分期杂交治疗的抗凝与抗血小板临床经验总结

目的 冠状动脉分期杂交技术是治疗冠心病多支血管病变的一种新方法,围手术期抗凝与抗血小板治疗方案目前尚无统一治疗方案,本研究中探索抗凝与抗血小板治疗方案的安全性和有效性。 方法 2015年12月至2016年8月,20例经冠状动脉造影确诊为多支冠状动脉病变的冠心病患者接受分期杂交冠状动脉治疗。按照制定的治疗计划,患者首先接受微创不停跳左乳内动脉至前降支搭桥,5天后接受冠状动脉介入治疗非前降支血管。外科手术前服用阿司匹林100mg/日连续5天以上;手术中使用肝素1-3mg/kg,维持活化凝血时间大于300秒,术毕鱼精蛋白中和肝素比例为1:2。手术后第一日起口服阿司匹林100mg/日+氯吡格雷75mg/日直至第五日接受冠脉介入治疗,完成冠脉介入治疗之后终生服用阿司匹林100mg/天以及一年硫酸氯吡格雷75mg/天。评价住院期间以及随访1年的主要心脑血管不良事件,统计出血并发症,总结临床治疗效果,评价本研究方案的安全性和有效性。 结果 20例患者均按计划顺利接受冠状动脉分期杂交治疗。住院期间以及随访1年内主要心脑血管不良事件发生率为0%。患者出血风险未增加。 结论 本研究中冠状动脉分期杂交治疗所采用的围手术期抗凝以及抗血小板治疗方案安全、有效。     

杂交技术对老年多支复杂冠心病患者早期疗效及预后的影响

目的探讨分期非体外循环微创冠状动脉搭桥(MIDCAB)联合经皮冠状动脉介入(PCI)杂交技术治疗老年多支复杂冠心病患者的早期疗效及预后。方法选取31例年龄60~83岁多支复杂冠心病患者,用血管内超声(IVUS)和血流储备分数(FFR)对病变进行评估,采取分期非体外循环对前降支(LAD)和左内乳动脉(LIMA)行微创冠状动脉搭桥(MIDCAB),对非LAD血管右冠状动脉(RCA)和回旋支(LCX)植入支架。观察早期院内指标及随访1~3年主要心血管不良事件情况。结果复杂病变(B2+C型)占83.2%,人均植入支架1.6个,人均再血管化2.6支,合理使用抗凝抗血小板药物,胸腔引流量(312±195)ml,输血占29%,术后脱机时间(8.0±3.2)h,ICU时间(24±8)h,无PCI及MIDCAB死亡病例,无二次开胸及脑卒中。随访1~3年再血管化PCI 2例,均非LAD病变,再发心绞痛4例,无心源性死亡、急性心肌梗死及急性心衰病例。结论合理选择病例,科学评估病变,分期杂交技术可用于多支复杂病变的老年冠心病患者,早期及预后安全有效。     

分站式杂交冠状动脉血运重建术治疗多支血管病变的经验

目的总结经左胸部小切口冠状动脉旁路移植术(MIDCAB)与经皮冠状动脉介入(PCI)治疗相结合的分站式杂交手术(Hybrid)治疗复杂冠状动脉多支血管病变的临床经验。方法 2011年1月至2014年10月,郑州市第七人民医院共26例包括冠状动脉前降支病变在内的多支血管病变患者接受分站式杂交手术治疗,其中男17例,女9例,年龄(54.3±8.5)岁。研究终点为无主要心脑血管不良事件生存率。结果本组患者均顺利实施分站式冠状动脉血运重建,全部行左侧内乳动脉至前降支冠状动脉旁路移植术,置入药物洗脱支架42枚,无院内及手术相关死亡。所有患者术后均得到随访,随访时间(18.0±9.2)个月,1例患者因钝缘支狭窄、1例患者因右冠状动脉支架内狭窄再次接受经皮冠状动脉介入治疗。全组无心肌梗死及死亡。结论分站式杂交手术治疗多支冠状动脉血管病变安全有效,近中期效果良好。     

一站式复合血管重建技术治疗无保护左主干病变

目的 评价一站式复合血管重建技术治疗无保护左主干病变的可行性和安全性.方法 2007年6月至2009年4月共有14例左主干病变患者接受一站式复合血管重建技术再血管化.其中男性13例,女性1例,平均年龄(60.4±15.4)岁,冠状动脉造影显示左主干开口或体部病变5例,远端或分叉病变11例.手术在一站式复合手术室内进行.通过胸骨下段小切口在心脏不停跳状态下行微创冠状动脉旁路移植术(左乳内动脉至前降支旁路移植),同期对左主干病变和(或)其他非前降支病变行经皮冠状动脉介入治疗.结果 14例患者均顺利进行一站式复合手术.即刻冠状动脉造影显示左乳内动脉桥均通畅.共有25处非前降支病变接受经皮冠状动脉介入治疗,其中23处病变置入支架(药物洗脱支架27枚,金属裸支架2枚),其余2处病变仅行冠状动脉球囊扩张术.围术期及随访期间无死亡、围术期心肌梗死、脑卒中或再次再血管化等发生.平均随访7.9个月(1～15个月),所有患者均存活且无再发心绞痛.5例患者术后1年再次接受冠状动脉造影,证实左乳内动脉桥及支架均通畅.结论 一站式复合血管重建技术治疗经选择的无保护左主干病变尤其是合并高危因素者安全可行.     

介入治疗中分支血管不同处理方法的疗效观察

分叉病变的介入治疗由于会引起冠状动脉分支血管的狭窄或闭塞，一直受到介入医师的关注。冠状动脉主支置入支架后分支血管开口病变的介入方法有支架置入、单纯球囊扩张或不予处理。本研究总结了我院近年来对中等大小分支血管的治疗情况，试图发现有效的治疗方法。     

药物涂层支架在冠心病治疗中的应用

近年来，随着人们生活水平的提高及生活方式的改变，患冠心病的人越来越多，且发病年龄呈下降趋势，冠心病已成为心脑血管疾病中的高发病。目前冠心病的治疗方式主要有内科介入治疗（PCI）、外科冠状动脉血管移植手术（CABG，即冠脉搭桥手术）以及内科药物治疗。而冠状动脉内支架置入术已成为冠心病介入治疗最主要的手段和方式，约80％的接受介入治疗的患者置入了支架。支架置入术开始用于临床时主要用在做冠状动脉球囊扩张时并发血管夹层、急性闭塞或濒临闭塞等情况，紧急置入支架以保持血流畅通，避免急诊外科手术及急性心肌梗死的发生。     

糖尿病多支冠状动脉病变患者不同血管重建疗效的比较

目的:评价对糖尿病多支冠状动脉病变患者的裸支架(BMS)置入、药物洗脱支架(DES)置入和冠状动脉搭桥手术(CABG)3种不同血管重建的疗效。方法:选择接受血管重建治疗的糖尿病伴多支冠状动脉病变患者427例,比较其BMS、DES和CABG不同治疗方法的疗效和随访2年的临床结果。结果:BMS、DES和CABG3组间住院时期的不良心脑血管事件(MACCE)发生率比较,差异均无统计学意义。2年随访结果中,BMS组、DES组再次血管重建率分别为17.6%、10.4%,均显著高于CABG组的1.9%(P<0.01);BMS组的总MACCE发生率为23.1%,显著高于CABG组的10.7%(P<0.01),而DES的总MACCE发生率与CABG组相比差异无统计学意义。结论:糖尿病多支血管病变患者置入BMS后再次血管重建率和总MACCE发生率显著高于CABG,而DES的中期临床疗效并不逊于CABG。     

微创冠状动脉杂交在冠状动脉多支病变中的临床应用

目的:回顾性分析我院近年来开展的微创冠状动脉杂交(HCR)手术的临床经验及中期随访结果。方法:2010年7月至2018年12月,北京安贞医院心外八科微创病房共开展微创HCR手术57例。其中男性43例,女性14例,平均年龄(58.1±11.8)岁,一站式HCR手术4例,分站式杂交手术中先微创冠状动脉旁路移植(MIDCAB)再支架置入33例,先冠状动脉支架置入再行MIDCAB 20例。以主要不良终点事件作为标志进行随访分析。结果:57例杂交手术,其中外科MIDCAB 60根,内科冠状动脉支架置入79枚,平均1.375枚,药物球囊扩张1例,围术期死亡1例,其余均顺利出院。随访1～101个月,1例患者术后6个月死于脑出血,1例死于其他疾病,3例患者因复发心绞痛再行冠状动脉造影检查,主要不良事件发生率8.8%。结论:微创HCR手术在有特定指征的病例中有较理想的手术效果,值得在临床推广应用。     

经左侧桡动脉行冠状动脉造影检查和介入治疗的疗效分析

目的观察经左侧桡动脉途径行冠状动脉造影检查和介入治疗的可行性和安全性。方法273例患者接受左侧桡动脉途径行冠状动脉造影检查及介入治疗，冠心病不稳定型心绞痛129例，心肌梗死61例，其中急性心肌梗死24例、陈旧心肌梗死37例，胸痛待查83例。结果冠心病185例，冠脉三支病变52例，双支病变54例，单支病变79例，正常冠脉88例。对其中111例患者的143支血管155处病变行介入治疗，置入支架152枚。经左侧桡动脉介入治疗成功率98．2％（268／273）。不成功的5例改用股动脉途径后行介入治疗均获成功。结论经左侧桡动脉途径行冠状动脉造影检查和介入治疗是一种安全、有效、可行的治疗方法。     

Coronary Sarcoidosis Presenting as Acute Coronary Syndrome

Sarcoidosis is a systemic disorder of uncertain etiology characterized by noncaseating granulomatous inflammation. The disease often involves the heart on autopsy, but the antemortem diagnosis of cardiac sarcoidosis is frequently missed. Cardiac involvement usually includes granulomatous inflammation or fibrosis of the myocardium, conduction system, or pericardium. We now describe a case of epicardial coronary involvement by sarcoidosis, where the diagnosis was made by surgical biopsy of the coronary artery in an African American man presenting with acute coronary syndrome and recurrent symptomatic restenosis following coronary intervention. The case extends the spectrum of common cardiac syndromes that cardiac sarcoidosis can masquerade as and highlights the importance of maintaining a high index of suspicion for early recognition and instituting specific treatment that might improve prognosis. A review of the literature also suggests the need for improvement in diagnostic approaches and prospective clinical trials to establish the best management strategy for this disease. Copyright © 2009 Wiley Periodicals, Inc.     

Coronary Atherosclerotic Precursors of Acute Coronary Syndromes

Background

The association of atherosclerotic features with first acute coronary syndromes (ACS) has not accounted for plaque burden.

Coronary Thromboembolism with Fatal Outcome Following Coronary Angiography

ABSTRACT A case of fatal thromboembolic occlusion of the left coronary artery at selective coronary arteriography is described. The course of events and the findings at autopsy suggest that thrombotic material was deposited on one intravascular catheter and transferred to a second catheter inserted over the same guide wire. Contrast injection through the second catheter into the left coronary ostium resulted in immediate and fatal occlusion of the two major branches of the left coronary artery.     

Spontaneous Multivessel Coronary Spasm During Diagnostic Coronary Angiography

Acute vasospastic angina, formerly known as Prinzmetal angina, is characterized by transient electrocardiographic changes that are not related to exertion. Its atypical presentation makes it difficult to establish the diagnosis, so it is probably underrecognized and therefore mismanaged. We treated a 49-year-old woman who presented with a 2-day history of chest pain associated with palpitations. Abnormal radionuclide stress test results prompted diagnostic coronary angiography, during which the patient reported chest pain and became hemodynamically unstable. Active coronary vasospasm at multiple sites was treated with intracoronary nitroglycerin and nicardipine, leading to immediate recovery.Our case highlights the importance of accurate, timely diagnosis of vasospastic angina, and of early recognition and management of spontaneous coronary spasm during angiography.     

Coronary collaterals

A 79-year-old man with onset of typical angina pectoris wasreferred to our institution for suspected coronary artery disease.We performed non-invasive coronary angiography using     

Coronary microembolization

Atherosclerotic plaque rupture is a key event in the pathogenesis of acute coronary syndromes and during coronary interventions. Atherosclerotic plaque rupture does not always result in complete thrombotic occlusion of the entire epicardial coronary artery with subsequent acute myocardial infarction, but may in milder forms result in the embolization of atherosclerotic and thrombotic debris into the coronary microcirculation. This review summarizes the available morphological evidence for coronary microembolization in patients who died from coronary artery disease, most notably from sudden death. Then the experimental pathophysiology of coronary microembolization in animal models of acute coronary syndromes is detailed. Finally, the review presents the available clinical evidence for coronary microembolization in patients, highlights its key features--arrhythmias, contractile dysfunction, microinfarcts and reduced coronary reserve--, compares these features to those of the experimental model and addresses its prevention by mechanical protection devices and glycoprotein IIb/IIIa antagonism.     

Coronary Thrombolysis

Myocardial infarction (MI) size is the major determinant of the function of the left ventricle and thus of the prognosis of the patient. Attempts to limit infarct size therefore constitute an important goal in modern coronary care. There is evidence that intravenous thrombolytic therapy can lyse coronary artery thrombi, restore antegrade coronary blood flow, preserve myocardial viability and function and improve survival. The time interval from onset of infarction, the extent of remaining ischemic myocardium and the rate at which myocardial necrosis is progressing are factors influencing the extent of myocardial salvage in reperfusion.