球囊封堵法建立猪急性心肌梗死模型及MR判定

目的:运用球囊封堵法建立猪急性心肌梗死(AMI)模型,通过磁共振(MR)判定模型建成与否。方法:实验使用12头小型猪,麻醉后经右侧股动脉将球囊导管置入至左前降支第1对角支下方0.5~1.0 cm处堵闭90 min,直至心电图证实AMI形成,并行MR True Fisp-PSIR序列心肌延迟灌注扫描及HE染色。结果:12头小型猪中10头成功建立AMI模型,MR延迟灌注扫描在T1WI双反转序列上,室间隔呈半月形低信号。HE染色法显示,封堵血管远端的心肌细胞核淡染、胞浆溶解。结论:冠状动脉球囊堵法是一种简单安全的建立AMI模型的方法,MR可更直观地观察到梗死区面积、组织水肿及心功能改变。     

CARTO电压标测识别猪急性心肌梗死模型中存活心肌的研究

目的 研究应用CARTO电压标测的方法识别猪急性心肌梗死模型中存活心肌的准确性和实用性.方法 用普通家猪13头,麻醉气管插管后行冠状动脉造影术,置入经皮腔内冠状动脉成形术球囊至冠状动脉左前降支远端,堵闭血流60～90 min,建立家猪心肌梗死模型.采用CARTO电压标测系统构建左心室,通过电压标测识别存活心肌.处死试验动物取出心脏,将心肌组织切成薄片后采用氯化三苯基四氮唑(TTC)染色法识别存活心肌.CARTO电压标测识别存活心肌的标准为0.5～1.5 mV为存活心肌,TTC染色存活心肌呈淡红色.将CARTO电压标测的结果与TTC染色结果进行对比.结果 所有猪均完成冠状动脉左前降支远端的封堵,2头分别在堵闭45和65 min时因心室颤动死亡.存活11头猪成功地建立急性心肌梗死模型.将猪的左心室分为16个节段,11头共176个节段,分别通过CARTO电压标测与TTC染色法对各节段心肌进行识别并评价两种方法的一致性,两者的一致性较好(Kappa=0.816,P＜0.001).以TTC染色检测出的存活心肌为标准,CARTO电压标测检测存活心肌的敏感度为71.8%,特异度为96.5%;准确度为90.9%.结论 运用经皮腔内冠状动脉成形术球囊封堵冠状动脉可成功建立猪急性心肌梗死模型.通过CARTO电压标测系统能够识别出模型中的存活心肌,为检测存活心肌提供了一个新的方法.     

冠状动脉堵闭法建立猪心肌梗死模型

探讨运用经皮腔内冠状动脉成形术球囊堵闭猪冠状动脉建立急性心肌梗死动物模型的实验方法。选用苏中幼猪11只，麻醉后经股动脉或颈总动脉置入经皮腔内冠状动脉成形术球囊至冠状动脉左前降支远端，堵闭血流120min。观察心电图、心肌酶、心脏二维超声检查及冠状动脉和左心室造影。结果发现，存活7只猪均完成冠状动脉左前降支远端的封堵，心电图显示急性心肌梗死典型图形变化，血浆肌钙蛋白明显升高并呈动态演变：术后1h超声检查出现间隔上部及前壁局部运动异常；术后2至4周造影复查显示左心室前壁、心尖部心室壁异常运动；存活7只猪均成功地建立急性心肌梗死模型。另4只猪分别在堵闭60～100min因心室纤颤死亡。结果提示，运用经皮腔内冠状动脉成形术球囊封堵冠状动脉可成功建立猪急性心肌梗死模型，并保持封堵冠状动脉通畅；与开胸法相比更接近人体状态，具有创伤小、动物生存时间长并易于术后馒头等优点。     

急性心肌梗死区经冠状动脉病变血管植入体外培养扩增的自体骨髓间充质干细胞疗效试验研究

目的研究冠状动脉病变血管经导管植入体外培养扩增的自体骨髓间充质干细胞(MSCs)至急性心肌梗死区的治疗效果。方法体外扩增培养巴马香猪MSCs。球囊扩张封堵冠状动脉前降支制备巴马香猪急性心肌梗死模型,成模1个月后,冠状动脉前降支经导管植入体外扩增培养的自体MSCs至急性心肌梗死区。结果梯度离心法分离结合贴壁筛选法体外扩增培养的巴马香猪MSCs第3代细胞表面标记物CD71阳性率为95%,CD34的阳性率为0.0%。传代培养四代后,细胞开始衰老。冠脉病变血管球囊导管法植入体外培养扩增的自体MSCs后4周,试验组梗死区可见BrdU阳性的植入的MSCs,对照组梗死区未见BrdU表达阳性细胞;试验组与对照组比较:射血分数55.4%±10.9%vs 41.3%±11.1%(P=0.04);舒张末期室间隔厚度(1.3±0.1)mm vs(0.9±0.1)mm(P=0.03);梗死面积26.8%±3.1%vs 33.2%±3.9%(P=0.035);新生血管(2.85±0.7)个/HPF vs(1.2±0.2)个/HPF。两组均未见横纹结构。试验组无严重并发症出现。结论冠状动脉病变血管经导管法植入体外培养扩增的自体MSCs治疗急性心肌梗死是有希望的新方法,值得进一步深入研究探讨。     

家猪急性心肌梗塞模型冠脉零流量压与存活心肌的相关性

目的:探索制备的家猪急性心肌梗塞模型中梗塞相关冠状动脉零流量压(Pzf)与存活心肌面积的关系。方法:普通家猪13只,冠脉造影结束后应用指引导管测量前降支近端压力,置入冠脉内多普勒导丝测量前降支远端冠脉内的血流速度,绘制压力-血流速度坐标轴,计算Pzf。将球囊送至冠状动脉左前降支中远端,堵闭血流60～100min,建立心梗模型。模型建立后重复测算前降支Pzf,分析心梗模型制备前后前降支Pzf数值的变化。处死试验动物,切片心肌采用TTC染色法识别梗塞心肌与存活心肌,采用图像分析仪分析代表存活心肌的颜色占整个左心室面积的百分数,将其与梗塞后前降支Pzf数值联合建立坐标轴,观察二者之间的关系。结果:所有家猪均完成冠状动脉左前降支远端的封堵,2只家猪分别在堵闭45和65min时因心室纤颤死亡。存活11只家猪均成功地建立急性心肌梗塞模型,完成Pzf数值的测算。心梗后前降支的Pzf[(53.06±23.01)mmHg]较心梗前[(40.13±19.53)mmHg]显著升高,P0.001。线性回归分析显示,TTc染色存活心肌占左心室面积的百分数与测得的Pzf值呈负相关(r=-0.879,P0.001)。结论:运用经皮腔内冠状动脉成形术球囊封堵冠状动脉可成功建立猪急性心肌梗塞模型,存活心肌的面积与相关血管的零血流量压呈负相关,提示零流量压的测定可以作为预测心梗后存活心肌范围的一个指标。     

非开胸法建立室壁瘤动物模型的实验研究

目的　探讨运用PTCA球囊封堵猪冠状动脉建立急性心肌梗死后室壁瘤的动物模型的实验方法。方法　选用家猪 7只 ,麻醉后经颈总动脉或股动脉置入PTCA球囊至左前降支 (LAD)第一对角支远端 ,对堵血流 15 0分钟。观察 :心电图、心肌酶、心脏二维超声检查及冠状动脉和左心室造影。结果　 7只猪均完成LAD的封堵 ,2只分别在堵闭 12 0分钟和 2 0分钟后因心室纤颤死亡。存活的 5只猪成功建立左室前壁急性心肌梗死模型 ,术后 6周造影复查示左室前壁、心尖部室壁瘤形成 ,4只猪堵闭的LAD远端闭塞。心电图显示急性心肌梗死的典型图形和动态演变过程。cTnI明显升高并呈动态演变。术后 1小时超声检查出现间隔上部及前壁局部运动异常 ,术后 2周即有室壁瘤形成。结论　运用PTCA球囊封堵冠状动脉可成功建立急性心肌梗死后室壁瘤的动物模型 ,与开胸法相比更接近人体的状态 ,具有创伤小、动物成活率高、生存时间长、技术要求不高等优点 ,可为进一步的研究提供较好的实验模型。     

经皮穿刺球囊封堵冠脉建立犬急性心肌梗死模型的实验研究

目的:探讨应用PTCA球囊封堵冠状动脉犬急性心肌梗死动物模型的实验方法。方法:选用杂种犬20只,麻醉后经股动脉置入PTCA球囊至左前降支（LAD）和左旋支（LCX）,封堵血流90min。结果:2只因指引导管致前降支闭塞发生心室纤颤死亡,2只因球囊封堵前降支近端约30min后发生心室纤颤死亡,4只在球囊拔除后发生心室纤颤死亡,1只封堵左旋支中段犬在心肌梗死后20h死亡。其余11只动物成功建立急性心肌梗死模型。前降支封堵术后1周,行超声心动图检查出现室间上部及前壁局部运动异常,室壁也变薄。结论:运用PTCA球囊封堵冠状动脉成功建立急性心肌梗死动物模型,可为研究提供较好的实验模型。     

促红细胞生成素对心肌梗死大鼠血流动力学及梗死面积的影响

目的探讨重组人促红细胞生成素(rhEPO)对大鼠急性心肌梗死(AMI)后24h血流动力学和左心室梗死面积的影响。方法 24只雄性SD大鼠随机分为假手术组、AMI组和EPO组,结扎左冠状动脉前降支建大鼠AMI模型,EPO组同时给予rhEPO5000U/kg腹腔内注射;24h后记录大鼠血流动力学参数并计算左心室梗死区与左心室质量比值。结果 AMI组各项血流动力学参数均明显下降;EPO组血流动力学参数均明显改善(P0.05,P0.01),尤其反映心肌舒张功能的指标改善更显著(P0.01);EPO明显降低左心室梗死区与左心室质量比值(P0.05)。结论 EPO急性干预缩小大鼠AMI后的梗死面积并明显改善其血流动力学参数,尤其对舒张功能改善更为明显。     

慢性冠状动脉狭窄及慢性心肌冬眠模型的制作研究

目的建立慢性冠状动脉狭窄及慢性心肌冬眠的动物模型。方法采用球囊扩张及内膜剥脱技术造成冠状动脉左前降支(LAD)中段狭窄、心肌慢性缺血,建立小型猪慢性心肌冬模型。24只小型猪分成慢性心肌冬眠4周组(CHM4W组,6例)、假手术4周组(6例)、慢性心肌冬眠12周组(CHM12W组,6例)和假手术12周组(6例)。分别于球囊扩张及内膜剥脱术或假手术后4周和12周终止研究。冠脉造影观察LAD中段狭窄程度,超声心动图观察左心室壁运动。结果CHM4W组及CHM12W组动物LAD直径平均狭窄率(91.9±5.2)%,病变平均长度(13.4±2.8)mm;共检出46个左室壁异常运动节段,腺苷负荷超声心动图实验39个节段出现室壁运动障碍程度先加重而后改善的典型冬眠心肌的双相反应。结论通过球囊扩张及内膜剥脱技术成功建立了猪慢性心肌冬眠模型,模型制作方法简单,成功率高,动物死亡率低。     

小型猪急性心肌梗死经皮冠状动脉再通后无复流模型的建立

目的复制小型猪急性心肌梗死冠状动脉再通(AMI-PCI)后无复流(no-reflow)现象,提供更为接近人类心血管组织生物学特性的动物模型。方法小型猪20头,雌雄不限,行左、右冠状动脉造影和左心室造影,并记录有创血流动力学参数,通过球囊闭塞、微血栓注入造成左前降支(LAD)无复流。监测心电图变化。结果(1)制模共有16头小型猪成活,其中14头达到AMI-PCI后无复流动物模型标准[TIMI血流≤2级,校正的TIMI血流记帧法(CTFC)≥36.2帧],制模成功率为70%。(2)小型猪在无复流模型建立成功后较闭塞前心率增快、血压下降、心肌耗氧量(PRI)增加、左心室舒张期末压(LVEDP)升高、肺毛细血管楔压(PCWP)升高,较闭塞前差异均具有统计学意义(P<0.05)。(3)在整个实验中,体表心电图和冠状动脉内心电图的演变均出现类似人类急性心肌梗死缺血再灌注的心电图演变规律。结论通过选择性冠状动脉前降支急性闭塞、再灌注、微血栓注入制备的无复流小型猪模型是无复流研究中一种较理想的实验动物模型。     

Pseudoaneurysm of coronary artery following rupture of coronary artery during coronary angioplasty.

Rupture of the coronary artery is a rare complication of percutaneous transluminal coronary angioplasty (PTCA). We describe a case of coronary artery rupture during PTCA resulting in the formation of a coronary artery pseudoaneurysm. The pseudoaneurysm was successfully treated by percutaneous spring-coil embolization of the coronary artery.     

Percutaneous coronary intervention of bifurcation coronary disease

Bifurcation coronary artery disease is a frequent problem faced by interventional cardiologists and it affects approximately 15-20% of patients undergoing percutaneous coronary intervention (PCI). The application of drug-eluting stents (DES) technology to prevent restenosis after PCI represents one of the success stories in cardiology, but DES have not resolved the bifurcation PCI challenge. Bifurcation PCI remains associated with higher procedural failure and worse outcomes compared with PCI of non-bifurcated lesions even in DES era. A dependable strategy for PCI of bifurcation lesions has yet to be established, which is likely due to the paucity of studies evaluating the anatomical intricacies of the bifurcation as well as the lack of large scale randomized therapeutic trials. Further, bifurcation has many anatomical variants and it is unlike that one technique will fit all. Currently, we are left with the option of a tailor-made strategy for each patient and bifurcation anatomy and make the most of the limited evidence available to support our therapeutic decisions. In this review, we attempted to describe the current understanding of bifurcation anatomy and corresponding PCI strategies.     

Atherosclerosis of coronary arteries, coronary heart disease and sudden coronary death

Correlation between the severity of coronary atherosclerosis, thrombosis and sudden cardiac death was examined in 721 autopsied cases. Severe coronary atherosclerosis with stenosis was found in most of them; however a similar grade of atherosclerosis was discovered in patients with ischaemic heart disease not dying suddenly. Acute coronary thrombosis in the studied subjects was diagnosed post mortem in about 20 percent of those who died suddenly. Other studies indicate frequencies between 4-93%. There was no consistent time dependence.     

Clinical trials of coronary revascularization: coronary angioplasty vs. coronary bypass grafting

In the absence of diabetes mellitus, rates of survival and of survival free of myocardial infarction (MI) are almost identical among patients with multivessel disease assigned to percutaneous transluminal coronary angioplasty (PTCA) versus those assigned to coronary artery bypass grafting (CABG) after 6.5 to 8 year follow-up period. Additional revascularization occurs 2.5 to 4.5 times more frequently in PTCA-treated than in CABG-treated patients and prevalence of angina is no longer statistically different between the two treatment groups. The excess health care costs of bypass surgery, which are important early after revascularization, almost disappear 5 to 8 years later. In patients with single vessel disease, survival free of MI is also comparable in both treatment groups at 5 years. Additional revasculariztion occurs two to four times more often in PTCA-treated than in CABG-treated patients and prevalence of angina does not differ between the two treatment groups. Thus, in nondiabetic patients with multivessel disease, the choice of a revascularization strategy rests on the patient's and treating physician's preference between the invasive nature of bypass surgery and the risk of recurrent procedures. In patients with single vessel disease, these long-term data suggest that bypass surgery is at least as safe and effective as coronary angioplasty and therefore may be a treatment option in selected cases.     

冠状动脉256排CT与冠状动脉造影对冠心病的诊断比较

目的冠状动脉256排CT成像技术与冠状动脉造影检查对冠状动脉粥样硬化性心脏病的诊断比较。方法选取2013年5月至2014年5月内蒙古兴安盟人民医院心血管内科疑似冠心病患者50例,其中男性29例,女性21例,年龄37~68岁。先行冠状动脉256排CT扫描及图像后处理,后行冠状动脉造影检查,将两结果进行对比分析。结果以冠状动脉狭窄≥50%者为阳性。冠状动脉256排CT诊断冠心病灵敏度为40.00%,特异度98.18%,阳性预测值88.89%,阴性预测值81.82%,正确指数38.18%,符合率82.67%,KAPPA值46.28%。结论冠状动脉造影诊断冠心病准确性优于冠状动脉CT。冠状动脉CT可对冠心病患者进行初筛诊断。     

冠脉微循环与冠心病

冠心病急性心肌梗死的再灌注治疗是现代医学发展的里程碑,它使被动、保守治疗转为积极、主动的血运重建,随着包括静脉溶栓、冠状动脉内溶栓、经皮冠状动脉腔内成形术(PTCA)、冠状动脉内支架置入术以及冠状动脉搭桥术等再灌注治疗技术的成熟、普及,挽救了无数患者的生命.     

Percutaneous transluminal coronary angioplasty of coronary artery embolism

A 35-yr-old woman with known valvular heart disease presented with acute myocardial infarction. Angiography demonstrated a totally occluded distal left anterior descending coronary artery. Though initially successful, angioplasty ultimately failed to maintain arterial patency, leaving a more distal total occlusion after several balloon inflations. In spite of this, PTCA possibly provided a more localized infarction via a peripheral mobilization of the embolus.     

Right coronary artery coronary sinus fistula with coronary sinus ostium stenosis

Coronary artery fistula (CAF) is a rare anomaly of the coronary artery. The draining site of a right coronary artery (RCA) fistula may usually be the right ventricle, right atrium, or pulmonary artery. Here, we present a patient with right coronary artery to coronary sinus fistula (RCACSF) complicated by aneurysmal dilatation of the coronary sinus (CS) and stenosis of CS ostium.     

Detecting of coronary dissection by coronary magnetic resonance

A 75-year-old man, who had a history of coronary dissection after percutaneous coronary intervention in left anterior descending coronary artery, underwent coronary magnetic resonance. Magnetic resonance demonstrated coronary dissection in the distal portion of the left anterior descending artery. Both the true lumen with thick vessel wall and the false lumen with thin vessel wall were demonstrated in the cross-sectional images using T1-weighed black blood technique and T2-weighed black blood technique. Soft plaque was located at the twelve o'clock in the true lumen. Invasive coronary angiogram showed long coronary dissection from middle to distal portion of left anterior descending coronary artery. Magnetic resonance was thought to be useful to detect and follow up the coronary dissection noninvasively.