2 cases of coronary embolism. Angiographic diagnosis and anatomopathological confirmation

The authors report two cases selected from a series of 61 cases of coronary embolism observed over an 18 year period at the Cardiovascular Hospital (Lyon) out of 4,860 autopsies of adult patients who died of cardiovascular causes. These two cases underwent coronary angiography, the results of which correlated with the autopsy findings. The authors review the causes and clinical manifestations of coronary embolism and compare their results with previously reported data, to establish the radiological features of coronary embolism. They notice the regular appearance of obstruction due to embolism and underline the importance of the associated negative signs (normality of the rest of the coronary circulation, absence of collateral vessels...) which makes the angiographic diagnosis one of elimination.     

医源性假性动脉瘤28例的治疗

医源性假性动脉瘤是指由于医护人员在对患者进行诊断和治疗过程中造成的假性动脉瘤,通常是在有创操作后发生的,最多见于动脉造影和经动脉行介入治疗后[1].根据假性动脉瘤的不同,我们采用了多种手段进行处理,均取得了成功,现总结如下.……     

Angiographic diagnosis of coronary sinus ostium atresia

Atresia of the ostium of the coronary sinus is a rare cardiac anomaly that has been diagnosed exclusively at necropsy¹.     

致心律失常性右心室心肌病的造影诊断

目的 评价心血管造影术(angiocardiography,ACG)对致心律失常性右心室心肌病(arrhythmogenicright ventricular cardiomyopathy,ARVC)的诊断价值和限度.方法 对11例临床确诊ARVC的患者行左心室、右心室造影,观察其形态及运动功能(特别是漏斗流出道、心尖小梁部以及下壁).结果 11例均行右心室造影,形态上表现为漏斗流出道扩张,其中7例为局限性扩张,3例为局限性扩张并囊袋状突出,1例为局限性扩张并叠盘状影;心尖小梁部8例叠盘状影,2例囊袋状突出,1例叠盘状影并囊袋状突出;下壁9例囊袋状突出,1例叠盘状影,1例囊袋状突出并叠盘状影.在运动功能异常方面,运动减弱最明显,分别见于漏斗流出道8/11,心尖小梁部10/11,下壁10/11;其次为无运动,分别发生在漏斗流出道2/11,心尖小梁部1/11,下壁1/11.1例还另行左心室造影,表现为:小梁粗大,心尖囊袋状突起,切迹,室间隔光滑.结论 右心室造影,征象明确,只要抓住发育不良三角形态及功能变化,就能作出正确诊断.ACG是ARVC诊断和鉴别诊断的重要依据.     

Echophonocardiographic diagnosis of left ventricular pseudoaneurysm.

We report the presence of an unusual systolic murmur associated with a traumatic left ventricular pseudoaneurysm. Echophonocardiographic studies showed the murmur to begin at the first heart sound, but end well before the second heart sound. It seems likely that the murmur is caused by the systolic flow of blood from the left ventricle into the relatively noncompliant pseudoaneurysm. The echocardiographic scan of the left ventricle demonstrated a relatively echo-free space posterior to the left ventricular wall, supporting the diagnosis of pseudoaneurysm, which has confirmed with angiographic studies and at surgery. These findings indicate that a combination of noninvasive techniques is useful in establishing this diagnosis.     

Non-invasive diagnosis of pseudoaneurysm of left ventricle.

A patient free of symptoms, with a pseudoaneurysm of the left ventricle after inferoposterolateral myocardial infarction, is reported. The diagnosis was established by nuclear cardiography and echocardiography of the left ventricle.     

Angiographic diagnosis of posterior mitral valve leaflet prolapse

The left ventricular cineangiograms of 22 asymptomatic, apparently healthy male aviators without noninvasive (echocardiographic or auscultatory) evidence of mitral valve prolapse were reviewed and compared with those of 12 men with noninvasive evidence of mild mitral valve prolapse. The maximal protrusion of the posterior mitral valve leaflet superior and posterior to a line perpendicular to the long axis of the left ventricle at end-systole was measured from the right anterior oblique left ventricular cineangiogram by repeated observation of left ventricular inflow. The values were 7.5 +/- 1.6 mm in patients without mitral valve prolapse and 11.2 +/- 3.4 mm in patients with mitral valve prolapse (mean +/- 1 standard deviation). This measurement did not exceed 11 mm in any patient without prolapse. It is concluded that: 1) with meticulous attention to angiographic landmarks of the left ventricular inflow area, the limits of normal systolic posterior mitral leaflet motion can be defined; and 2) systolic motion outside these limits constitutes a quantitative criterion for the angiographic diagnosis of mitral valve prolapse.     

Angiographic diagnosis of a bleeding jejunal diverticulum.

The authors report on the preoperative diagnosis of a bleeding jejunal diverticulum by selective arteriography. The angiographic findings, as well as the difficulties of the intraoperative localization of bleeding jejunal diverticula, are discussed.     

Incomplete differentiation of cardiac valves. Angiographic diagnosis

A case of incomplete differentiation of the cardiac valves is presented because of the antemortem demonstration of continuous visualization of the valvular structures on angiograms. We suggest that this angiographie finding in a child with congenital heart disease should raise the possibility of this lesion.     

104例冠状动脉血管内支架置入术后的血管造影随访研究

目的探讨影响冠状动脉内支架植入术后再狭窄的因素。方法对2001-2003年成功接受冠状动脉内支架植入术后患者进行定量冠状动脉造影,分析冠状动脉狭窄程度、病变长度及血管直径参数的影响。结果104例病人的138处病变植入152个支架,再狭窄率为35.5%。再狭窄组病变血管植入支架的长度(22±6)mm明显大于非再狭窄组(18±6)mm,(P<0.001)。短支架的再狭窄率显著小于长支架及植入多个支架者(P<0.01)。再狭窄组直径小于3.0mm中小血管的比例明显多于非再狭窄组。BX支架的再狭窄率最高,达46%,Supra-G的再狭窄率最低,为10.5%。结论冠状动脉内支架植入术后再狭窄与支架长度、构型等因素有关,小血管内植入支架仍须慎重。     

Primary coronary fistulas. Angiographic study of 21 cases

A retrospective study of 21 cases of congenital primary coronary fistulae and a review of the literature underline the exceptional features of 2 of our cases and recall the main features of coronary fistulae. Coronary angiography (18 cases) or aortography (3 cases) confirmed the diagnosis in our 21 cases. Six of them involved the right coronary artery, 12 the left one, and 3 the two coronary arteries. Seven of them involved the right heart (2 right atrium, 5 right ventricle), 11 the main pulmonary artery, 2 the left heart (the left ventricle in both cases), and the last case was a coronaro-bronchial fistula. Our series comprised 11 men and 10 women; the mean age was 33 (range: 4 days to 67 years of age). The main presenting features were: murmur (7 cases), angina (7 cases), angina (7 cases), Stage II or III dyspnoea (5 cases). Clinical examination showed a systolic-diastolic murmur in 12 cases and a systolic murmur in one case. The chest X ray showed signs of left to-right shunt in 6 cases. The right heart catheterisation of 16 of the 19 left-to-right shunts confirmed the shunt in 9 cases. The 7 cases of coronaro-right cardiac fistulae drained directly (4 cases), by aneurysmal dilatation with diaphragm (3 cases); the 2 cases of coronaro-left-ventricular fistulae drained via microfistulae; the 11 cases of proximal coronaro-pulmonary fistulae drained mostly by an angiomatous plexus (9 cases).(ABSTRACT TRUNCATED AT 250 WORDS)