冠状动脉旁路移植同期行二尖瓣成形术治疗缺血性二尖瓣关闭不全

目的总结缺血性二尖瓣关闭不全（IMR）患者同期行冠状动脉旁路移植术（CABG）和二尖瓣成形术的临床经验,以提高手术疗效。方法对36例IMR行CABG加同期二尖瓣成形术患者的临床资料进行回顾性分析。共移植血管93支,平均每例2.58支。二尖瓣成形采用Carpentier环6例,Duran环14例,交界褥式环缩16例;edgetoedge技术6例,后叶楔形切除2例。结果住院死亡5例（13.89%）,死亡原因：低心排血量、循环功能衰竭、肾功能衰竭和脑梗死。术后随访21例,失访10例,随访时间26.4±5.6个月,远期死亡3例。生存患者心功能分级（NYHA）级14例,级3例,级1例。随访期间复查超声心动图提示：二尖瓣无反流或微量反流4例,轻度反流13例,中度反流4例;心功能明显改善。结论对冠状动脉多支病变合并中度IMR患者应慎重选择二尖瓣成形手术,单纯CABG可能是首选的治疗方案。CABG同期行二尖瓣成形术治疗IMR早期效果较好,远期复发率高,但多数患者不需再次手术治疗。     

冠心病合并二尖瓣关闭不全的外科治疗

目的　探讨冠心病合并二尖瓣关闭不全 (MR)的外科治疗方法。方法　 1994年 4月至2 0 0 0年 10月 ,同期手术治疗冠心病合并MR病人 34例 ,其中二尖瓣轻度反流 1例 ,中度反流 2 5例 ,重度反流 8例。二尖瓣的病理改变主要表现为单纯瓣环扩大、瓣叶脱垂或二尖瓣腱索断裂。手术均在低温体外循环下进行。二尖瓣成形 (MVP) 2 7例 ;单纯二尖瓣前交界或双交界折叠环缩 15例 ;脱垂瓣叶切除后再缝合 9例 ;二尖瓣前叶脱垂部分直接缝合到相应的后叶形成双孔二尖瓣 3例 ;应用二尖瓣瓣环 2 0例 ;二尖瓣置换 (MVR) 7例 ,均选择机械瓣。结果　无手术或住院死亡和严重并发症。超声心动图检查提示平均左室舒张末径为 (5 3 0± 6 3)mm ,与术前比较差异有显著性 (P <0 0 1)。 31例平均随访 2 9个月。无远期死亡。病人生活质量均明显提高。心功能I～II级 2 8例 ,III级 3例。超声心动图检查提示微量二尖瓣反流 6例 ,少至中度反流 3例。机械瓣功能正常。结论　冠心病合并中度以上MR应积极处理 ,二尖瓣成形应为首选     

冠心病合并缺血性二尖瓣关闭不全的处理方法

目的　探讨冠心病合并缺血性二尖瓣关闭不全 (IMR)病例 ,在行冠状动脉旁路移植术(CABG)时是否要对二尖瓣进行处理及最合适的处理方法。方法　回顾分析 2 0 0 0年 1月至 2 0 0 3年 1 0月期间连续行CABG者中 37例合并IMR者在不同手术处理前后的变化。结果　术前合并有轻 -重度IMR者中 2 4例仅行CABG ,无手术死亡 ,术后 1周左室舒张直径由 5 2 95mm降至 4 8 1 8mm(P =0 0 0 1 ) ,左室射血分数从 0 46上升到 0 5 5 (P <0 0 0 1 ) ,二尖瓣反流面积 (MR)由 3 93cm2 下降至 1 48cm2 (P <0 0 0 1 ) ;1 3例同期行CABG和二尖瓣成形或置换 ,手术死亡 1例。结论　缺血性心脏病合并无二尖瓣明显病理结构改变的IMR ,单纯行再血管化后左心室收缩功能改善、IMR短期内明显减轻或消失。中度以上IMR并有二尖瓣发生病理结构改变时 ,需同期对二尖瓣进行干预 ,但是手术死亡率较高。     

瓣膜成形术治疗婴幼儿中重度先天性二尖瓣闭锁不全及其疗效分析

目的　总结婴幼儿中、重度先天性二尖瓣关闭不全 (MI)成形术的经验并探讨影响疗效的相关因素。　方法　 38例中、重度MI患者 ,其中单纯MI 5例 ,合并心内其他畸形 33例。本组患者平均年龄 (2 3± 1 2 )岁 ,<1 0岁的 5例 ;体重 (1 2 6± 3 9)kg ,<1 0 0kg的 1 3例 ,均在中低温体外循环下行二尖瓣成形和心内其他畸形矫治。术中根据二尖瓣病理变化的不同分别采用交界缝缩、部分瓣环环缩、瓣叶裂缺修补、腱索缩短和转移、人工腱索、后瓣成形等方法恢复二尖瓣功能 ,必要时可多种方法同时应用。　结果　本组患儿术后无一例死亡 ,无严重并发症 ;随访 2个月～ 6年 ,平均 (30±1 0 )个月。 1 1例二尖瓣反流消失 ,2 2例轻度反流 ,3例中度反流 ,2例中～重度反流 ;37例无临床症状 ,心功能Ⅰ级 ,1例心功能Ⅱ～Ⅲ级 ,需内科药物辅助。　结论　瓣膜成形术治疗婴幼儿先天性二尖瓣关闭不全可取得满意的早、中期效果 ;年龄和合并畸形不再是影响手术成败和术后疗效的主要因素。二尖瓣的病理变化对疗效有重要影响     

冠状动脉旁路移植术+二尖瓣成形术治疗冠心病合并缺血性二尖瓣关闭不全患者的疗效评价

目的探讨冠状动脉旁路移植术(CABG)+二尖瓣成形术(PBMV)治疗冠心病(CHD)合并缺血性二尖瓣关闭不全(IMR)的效果。方法选取2018-01-2019-01间郑州市第七人民医院收治的150例CHD合并IMR患者,按照手术方案分为2组,各75例。对照组采用CABG+二尖瓣置换术(MVR),观察组采用CABG+PBMV。比较2组治疗时间及术前、术后即刻心功能,包括左室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)。结果观察组ICU、术后呼吸机、住院时间均短于对照组,术后即刻LVEF大于对照组,LVEDD、LVESD小于对照组,差异均有统计学意义(P<0.05)。结论 CABG+PBMV治疗CHD合并IMR能缩短治疗时间,改善心功能。     

非体外循环冠状动脉旁路移植术后缺血性二尖瓣关闭不全患者的心功能改变

目的探讨非体外循环冠状动脉旁路移植术(off-pump CABG)对缺血性二尖瓣关闭不全患者心功能改变的影响,以提高治疗效果。方法53例缺血性二尖瓣关闭不全患者,男45例,女8例;年龄51～73岁,平均年龄63.3岁。53例患者均行off-pump CABG,术前及术后12个月分别采用超声心动图检测心功能改变及二尖瓣反流情况。结果术后3h死于突发心室颤动1例;术后发生大出血1例,于术后6h行二次开胸止血手术。随访52例,随访时间12个月,其中行超声心动图检查48例。术后12个月左心室收缩期末内径(34.75±6.83mm vs.38.80±7.21mm,t=-3.550,P=0.001),左心室舒张期末内径(50.50±10.31mm vs.53.85±11.20mm,t=-6.364,P=0.000)和二尖瓣反流面积(25.32%±9.80% vs.29.45%±12.30%,t=2.129,P=0.001)均较术前减小,左心室射血分数(62.10%±24.20% vs.57.75%±22.10%,t=2.132,P=0.038)较术前增加。结论冠心病合并中度二尖瓣关闭不全患者行off-pump CABG术后12个月二尖瓣反流量减少,左心室功能改善。     

二尖瓣成形术112例

目的总结先天性心脏病合并二尖瓣关闭不全患者的二尖瓣成形手术方法和临床效果. 方法 112例先天性心脏病患者主要病种为房室间隔缺损29例、室间隔缺损25例、动脉导管未闭14例、房间隔缺损14例等,合并二尖瓣关闭不全的主要病理改变为瓣环扩大58例、瓣叶裂隙37例、前、后瓣叶脱垂36例等.二尖瓣成形方法为瓣叶裂隙缝合34例,Cosgrove环环缩瓣环22例,交界环缩18例,双孔法14例等.术中左心室注水观察、评价成形后二尖瓣反流程度,脱离体外循环后食管超声心动图观察成形结果. 结果全组无死亡,1例因人工腱索断裂行二尖瓣置换术,术后门诊随访二尖瓣反流0 ～Ⅰ级72例,Ⅱ级26例.术前左心室舒张期末直径大于或等于45 mm 62例,术后随访左心房、左心室缩小,与术前比较差别有显著性意义(t=6.53,7.89,P<0.001). 结论先天性心脏病合并二尖瓣关闭不全病理改变较多,根据不同病理改变采取相应的二尖瓣成形方法,甚至需要同时采用多种措施才能获得满意效果;术中行食管超声心动图能为判断手术效果提供有益的帮助.     

非体外循环下采用自制二尖瓣成形装置手术治疗轻至中度缺血性二尖瓣关闭不全

目的尝试在非体外循环冠状动脉旁路移植术(OPCAB)期间对轻至中度缺血性二尖瓣反流(IMR)患者采用自制二尖瓣成形装置进行外科处理,并评估其疗效。方法回顾性分析自2009年9月至2011年8月北京安贞医院6例轻至中度IMR患者(男4例、女2例,年龄52～73岁)在OPCAB期间采用自制二尖瓣成形装置进行二尖瓣成形的临床资料。在处理IMR前及处理后通过经食管超声心动图测定IMR程度、二尖瓣瓣环前后径、左心室短轴径、左心室长轴径、左心室球形指数(左心室短轴径/左心室长轴径)等;通过Swan-Ganz导管测量并记录主动脉平均压、肺动脉平均压和中心静脉压等。比较围术期相关心功能指标。结果无住院死亡。二尖瓣成形后IMR均消失、二尖瓣瓣环前后径[(3.43±0.08)cm vs.(3.68±0.08)cm;t=5.430,P=0.001]、左心室短轴径[(4.80±0.21)cm vs.(5.53±0.11)cm;t=7.530,P=0.001]和左心室球形指数(0.64±0.02 vs.0.74±0.01;t=11.110,P=0.002)均较处理前明显减小;左心室长轴径无明显变化(P>0.05);术中血流动力学指标无明显变化。术后3个月6例患者(随访率100%)均在门诊复查,均无自主临床症状,心功能均改善至Ⅰ级(NYHA)。超声心动图提示:二尖瓣无反流4例,有微量反流2例。结论在OPCAB期间采用自制二尖瓣成形装置成形治疗IMR,直接完成了左心室塑型,规避了体外循环风险,即刻疗效确切,对循环指标影响甚小,有一定的临床应用价值。     

缘对缘瓣叶缝合技术治疗退行性二尖瓣关闭不全的临床分析

目的 探讨缘对缘瓣叶缝合技术的特点及其治疗退行性二尖瓣关闭不全的疗效.方法 回顾性分析2000年1月至2009年1月58例因退行性二尖瓣关闭不全行缘对缘瓣叶缝合技术治疗的患者的临床资料.58例患者中男性32例,女性26例;年龄43～65岁,平均(56±6)岁.二尖瓣中度反流18例,重度反流40例.前瓣叶脱垂50例,双瓣叶脱垂8例.58例患者均采用缘对缘瓣叶缝合技术,其中44例患者同期行瓣环成形术.通过电话、信件、门诊复查等方式进行随访.结果 围手术期无死亡和严重并发症发生.58例患者术后复查经胸超声心动图提示左心室、左心房明显缩小(P均＜0.05),二尖瓣反流明显改善(无反流9例、微量反流30例、轻度反流19例),且无狭窄发生.58例患者术后随访24～95个月,平均(58±20)个月.随访期间死亡2例,死亡原因均为非心源性.二尖瓣重度反流1例、中度反流3例,无狭窄发生.术后5年二尖瓣再次中重度反流免除率为91.9％.随访中根据手术时是否行瓣环成形术,将58例患者分成缘对缘瓣叶缝合组14例和缘对缘瓣叶缝合+瓣环成形组44例,生存分析显示,缘对缘瓣叶缝合+瓣环成形组患者术后远期二尖瓣再次中重度反流免除率更高(x2=4.034,P=0.045).结论 缘对缘瓣叶缝合技术治疗退行性二尖瓣关闭不全围手术期及术后远期成形效果良好,与瓣环成形技术联合应用可提高术后远期成形效果.     

单纯非体外循环冠状动脉旁路移植术或联合二尖瓣成形术治疗冠心病合并中度缺血性二尖瓣关闭不全的远期效果比较

目的比较非体外循环冠状动脉旁路移植术(CABG)和CABG联合二尖瓣成形术(MVP)治疗冠心病合并中度缺血性二尖瓣关闭不全的效果。方法回顾性分析2009年1月至2020年12月在首都医科大学附属北京安贞医院心脏外科诊断为冠心病合并中度二尖瓣关闭不全并接受外科手术的1 050例患者的临床资料。男性733例, 女性317例, 年龄(63.3±9.0)岁(范围:31～83岁)。按照手术方式将患者分为联合组(CABG+MVP)和CABG组(非体外循环CABG), 采用倾向性评分匹配法对两组患者进行1∶4匹配, 匹配后联合组107例, CABG组406例。采用t检验、Mann-WhitneyU检验、χ2检验、Fisher确切概率法或重复测量方差分析比较匹配后两组患者的手术情况及远期结局。结果两组的围手术期病死率和术后并发症发生率无明显差异(P值均>0.05)。联合组较CABG组的手术时间[(5.6±1.2)h比(4.2±1.0)h, t=11.528, P<0.01]、ICU停留时间[M(IQR)][43.0(47.3)h比25.0(33.6)h, Z=2.483, P=0.013]...     

冠状动脉内膜剥脱联合旁路移植治疗弥漫性冠状动脉狭窄病变的近中期效果

目的探讨冠状动脉内膜剥脱术(CE)联合冠状动脉旁路移植术(CABG)治疗弥漫性冠状动脉狭窄病变的近中期效果。方法回顾性分析2010年1月至2019年1月在南京市第一医院心胸血管外科接受CE+CABG的248例弥漫性冠状动脉狭窄病变患者的临床资料。男性201例,女性47例;年龄(65.6±8.5)岁(范围:43~79岁)。体外循环手术156例,非体外循环手术92例。共对269根病变血管完成CE,包括前降支108根,右冠状动脉140根,钝缘支21根。共完成旁路移植872支,包括左胸廓内动脉248支,桡动脉48支,大隐静脉576支,每例患者移植(3.5±0.8)支(范围:2~6支)。CE后平均血流量为(26±8)ml/min(范围:13~59 ml/min),血流指数为3.1±0.8(范围:2.0~6.7)。采用t检验或χ²检验比较体外循环和非体外循环患者的手术结果及术后通畅率。结果全组围手术期病死率为1.2%(3/248),2例死于肾功能衰竭,1例死于术后顽固性低心排血量。9例发生围手术期心肌梗死。随访(41.8±21.4)个月(范围:1~68个月)。旁路血管术后1年通畅率为78.4%(182/232),3年通畅率为69.8%(162/232)。左冠状动脉系统通畅率明显高于右冠状动脉系统(1年:87.4%比73.1%,χ²=6.533,P=0.011;3年:78.2%比64.8%,χ²=4.588,P=0.032)。体外循环组和非体外循环组旁路血管通畅率无差异(1年:80.0%比76.9%,χ²=0.277,P=0.599;3年:71.5%比67.9%,χ²=0.300,P=0.584)。结论CE+CABG治疗弥漫性冠状动脉狭窄病变可以获得较满意的完全再血管化,有较好的早、中期效果和旁路血管通畅率。体外循环和非体外循环手术具有相似的早中期结果。     

冠状动脉旁路移植术后左心辅助临床应用体会

目的：总结冠状动脉移植术（搭桥术）后使用左心机械辅助情况，为临床处理重症冠心病提供参考。方法：回顾分析了1704例搭桥术病人使用左心辅助的情况，并分析了其与并发症、病死率相关因素。结果：搭桥术病人左心机械辅助使用率为1.5％，脱机率76％，出院率48％。主要并发症为多发性器官功能衰竭（MOF）、出血等。死亡病人大多在脱机后发生，主要死因为MOF、肾功能不全、心功能衰竭。结论：搭桥术后左心机械辅助应强调早期使用，如有可能，小流量观察一段时间再停机。     

冠状动脉病变程度与冠心病危险因素的相关分析

目的探讨冠心病患者冠状动脉病变的严重程度与冠心病危险因素的关系。方法选择冠心病患者116例为冠心病组,选择冠状动脉样硬化狭窄程度〈50%的患者66例为对照组。分析冠状动脉狭窄程度与冠心病危险因素的关系。结果多因素分析结果显示,LVEF、Ccr与冠状动脉粥样硬化程度呈负相关,而hs-CRP与冠状动脉粥样硬化程度呈正相关（P〈0.05或P〈0.01）。结论冠状动脉狭窄程度与LVEF、Ccr呈负相关,与hs-CRP呈正相关。     

Coronary endarterectomy on beating heart: Our experience

Introduction Coronary artery bypass grafting (CABG) associated with Endarterectomy is a high risk procedure. After the first report of coronary endarterectomy by Bailey et al in 1951, the preference for this surgical procedure was decreased due to increased morbidity and mortality In patients with total or subtotal large coronary artery obstructions in which there is no possibility to receive a conduit as graft for myocardial revascularisation, endarterectomy remains the procedure of choice. This study was designed to study early and midterm results of off pump coronary artery endarterectomy. Methods Of 172 Consecutive Off Pump CABG done at our institution from Jan 2003 to July 2005, 22 patients underwent supplementary coronary endarterectomy. 16 patients had chronic stable angina 4 had unstable angina two required emergency CABG with endarterectomy following perioperative infarction. The mean ejection fraction was 29.2±4.3 and all of the patients were in New York Heart Association (NYHA) III or IV. All patients were planned for complete total arterial revascularisation using Left Internal Mammary Artery (LIMA). Right Internal Mammary Artery (RIMA), Radial composite “Y” graft, Two patients operated for periop infarct received vein graft. In 16 patients closed endarterectomy was done in five patients double endarterectomy in single vessel was done to chase the plaque distally, in one patient open left anterior descending (LAD) endarterectomy with vein patch reconstruction was performed. Results There were no deaths. None of the procedures were converted to on pump operation. All endarterectomies and bypasses were performed on Beating Heart, all patients were completely revascularised. Peri operative cardiac enzymes studied showed no significant rise in the Creatinine Phoshpokinase (CPK)-Creatinine Phosphokinase myocardial Band (CPK-MB). The mean postoperative Ejection Fraction (EF) was 36.7%±7.2% which was significantly higher than the Preoperative one (p<.05). At the end of four months to one and half year 22 patients were in NYHA class I to II and all were angina free in canadian cardiovascular society class.f Conclusions Coronary End Arterectomy without cardiopulmonary bypass can be performed in patients who are expected to benefit from complete revascularisation. It can be performed with closed as well as open method. However to achieve complete endarterectomy by closed technique in some patients it is essential to chase the plaque. Early and mid term results are encouraging.     

225例左主干狭窄冠状动脉旁路移植术

目的 总结冠状动脉左主干狭窄(LMS)的外科治疗效果和临床经验。方法1999年1月至2003年6月，225例LMS病人接受了冠状动脉旁路移植术(CABG)。平均年龄63．4岁。左室射血分数(LVEF)≤0．3011例。6例急诊手术，其中3例术前放置主动脉球囊反搏(IABP)。76例在常规体外循环下手术；149例应用非体外循环不停跳技术，术中改为体外循环5例。其中13例全动脉化、3例全静脉化旁路移植术。结果平均术前住院2．3d。平均每例远端吻合口2．95个。死亡13例(5．78％)。结论尽管LMS是预示CABG术后死亡率的独立危险因素，但CABG现在仍是其治疗的第一选择，且是安全、有效的方法。     

An Evaluation of Histomorphometric Properties of Coronary Arteries,Saphenous Vein,and Various Arterial Conduits for Coronary Artery Bypass Grafting

Purpose. We evaluated the histomorphological properties of the coronary arteries, saphenous vein, and five arterial conduits for coronary artery bypass grafting, and compared them with each other. Methods. All vessels were harvested from seven cadavers, eight autopsied individuals, and 14 patients. The length, lumen diameter, wall thickness, and histological structures were examined based on samples obtained from the coronary arteries and the conduits. The dimensions and wall thicknesses of the coronary arteries and the conduits were compared using a one-sided variance analysis. The similarities between the coronary arteries and the conduits were investigated by Duncan's multiple range tests. Results. The internal mammary and intercostal arteries were elastic, while the others were muscular. The lengths of all conduits were adequate for use as coronary artery grafts. The dimensions and wall thicknesses of the coronary arteries and the conduits showed no statistically significant differences, except for the proximal portion of the saphenous vein. Conclusions. These findings emphasize the justification of continued use of the ideally matching internal mammary artery, either as an in situ or free graft, in coronary artery bypass grafting, although other arterial grafts can be used in coronary artery bypass grafting. In addition, the intercostal artery was found to have relatively favorable properties regarding its potential suitability as a coronary bypass conduit.     

Safe evolution towards routine off-pump coronary artery bypass: negotiating the learning curve

Objective: Off-pump coronary artery bypass (OPCAB) hopes to avoid morbidity associated with cardiopulmonary bypass, improving clinical outcomes. Yet its technical difficulty and unfamiliarity raise concern that adoption of OPCAB might be associated with poorer outcomes during each surgeon's ‘learning curve’. We examined trends in patient selection over time as a single surgeon's practice evolved to routine OPCAB. Methods: Between 10-1-96 and 12-31-01, 1479 consecutive patients had isolated coronary artery bypass grafting (CABG). Clinical data were gathered prospectively and reviewed retrospectively. Trends in adoption of OPCAB and clinical outcomes were examined. Results: There were 756 OPCAB and 723 CABG/cardiopulmonary bypass patients. The practice evolved from 90% conventional CABG to 93% OPCAB. An abrupt transition coincided with evolution of techniques to expose the obtuse marginal arteries, and improvements in suction-based coronary stabilizers. Mortality was 1.0% for the off-pump group and 2.1% for the on-pump group. Careful patient selection helped maintain acceptable outcomes during the ‘learning curve’. Patients with depressed left ventricular ejection fraction, left main disease, and complex three vessel disease were excluded from OPCAB until significant experience (>200 cases) was attained. Presently, all isolated coronary bypass cases are candidates for OPCAB except patients with ischemic ventricular arrhythmias, those in cardiac arrest, and those for whom previous left pneumonectomy or deep pectus excavatum prevent rightward mobilization of heart. Conclusions: Despite a significant learning curve, evolution to routine OPCAB can be achieved while maintaining good patient outcomes. The development of specialized techniques, coronary stabilizers, and apical suction devices allows the application of OPCAB to virtually all coronary bypass patients, as surgeon experience matures.     

1110例冠状动脉搭桥术的早期结果

目的　回顾性总结１９９６ 年１ 月以来１１１０ 例冠状动脉搭桥术（ＣＡＢＧ） 的近期疗效,介绍冠心病搭桥术的体会和经验。　方法　体外循环下行ＣＡＢＧ１０４８ 例,非体外循环ＣＡＢＧ６０ 例。心肌保护均采用冷血含钾停跳液,体外循环时间１１５ ±３５ 分钟,主动脉阻断时间７２ ±２４ 分钟,单支搭桥１１０ 例,２ 支搭桥１４５ 例,３ 支搭桥４１５ 例（３７－３ ％） ,４ 支搭桥或４ 支以上４３９ 例（３９－５％） 。搭桥材料：左乳内动脉７５１ 例,大隐静脉８７７ 例,桡动脉１０１ 例,全动脉化７２ 例。合并手术：室壁瘤切除１１２ 例,室壁瘤折叠１４ 例,左室成形５ 例,瓣膜手术４８ 例,室间隔穿孔修补术５ 例。　结果　住院死亡９ 例,死亡率０－８１％ 。其余患者痊愈出院,心绞痛基本缓解。术后并发症：低心排１１ 例,主动脉球囊反搏７例,围术期心肌梗塞２ 例,脑部并发症３ 例,二次开胸止血４ 例。　结论　选择好靶血管和充分血管化是冠状动脉搭桥术的关键。另外要重视围术期处理。     

Combined surgical management of tuberculous constrictive pericarditis and coronary artery disease

The combination of constrictive pericarditis and coronary artery disease is rarely reported in medical literature. Constrictive pericarditis occurs after cardiac operations in 0.2–0.3 % of cases. Normal coronary vessels can be involved in the inflammatory process of constrictive pericarditis by scar tissue. The association between tuberculosis and coronary artery disease is rare. Obliteration of coronary vessels may occur in rare cases of tuberculous aortitis. We present a case of coronary artery disease associated with tuberculous constrictive pericarditis. Combined treatment by total pericardiectomy and coronary artery bypass surgery was successful.     

Is chlamydia pneumoniae associated with calcification in coronary atherosclerosis?

Background The various factors that initiate coronary atherosclerosis and calcification are unclear. Chlamydia pneumoniae has been implicated in several diseases, including atherosclerosis. The possible association of chlamydia pneumoniae with calcification in coronary atherosclerosis, has not been previously elucidated. Methods Coronary endarterectomy specimens were harvested from 73 patients (67 males, 6 females), aged 40 to 75 years (average age 58 years) at Coronary Artery Bypass Graft [CABG] operation, and analysed by immunohistology, Polymerase Chain Reaction [PCR], and electron microscopy. T-lymphocytes, macrophages, and Chlamydia pneumoniae were identified using appropriate cell-specific antibodies. Results Calcification was observed in all specimens, varying from calcific stippling to diffuse calcification. Numerous T-cells and macrophages were seen within atherosclerotic plaques and areas of calcification. Large numbers of cells that stained positive for the antibody to Chlamydia pneumoniae, were distributed in 69% of specimens within atherosclerotic plaques, especially within areas of calcification, in close association with inflammatory cells, but not in the adjacent normal segments. Deoxy-ribo DNA chlamydia pneumoniae was identified in 65% of specimens by PCR. Clumps of chlamydia pneumoniae were observed in about 61% of specimens by transmission electron microscopy. Conclusions This study demonstrated Chlamydia pneumoniae within foci of calcification in atherosclerotic coronary artery plaques obtained following endarterectomy in Indian patients. Chlamydia pneumoniae, in association with macrophages and T-lymphocytes, may contribute to the chronic inflammatory reactions resulting in calcification of atherosclerotic coronary plaques. This finding may improve the treatment of coronary artery disease since Chlamydia pneumoniae is sensitive to antibiotic therapy.