冠脉旋磨术在冠脉钙化病变中的应用效果

目的分析冠脉旋磨术在冠脉钙化病变中的应用效果及安全性。方法回顾性分析36例应用冠脉旋磨术治疗的冠脉严重钙化病变患者的临床资料,观察患者的手术治疗情况、冠脉病变血管变化情况、心功能指标、术后随访及不良事件发生情况。结果36例患者手术成功率为97.22%,手术治疗过程中未出现冠脉穿孔、心肌梗死、心源性死亡等并发症。术后,患者血管狭窄率显著低于术前,管腔直径显著大于术前(P<0.05)。所有患者均在术后半年复查心脏彩超,术前及术后半年的左室舒张末期内径、左室射血分数比较,差异不显著(P>0.05)。术后随访1年,36例患者均未再发心绞痛、靶血管重建、心肌梗死以及心源性死亡等不良事件。结论冠脉旋磨术治疗冠脉严重钙化病变的远期疗效好,安全性高。     

16层螺旋CT冠状动脉钙化积分在冠心病诊断中的应用价值研究

目的探讨16层螺旋CT冠状动脉钙化积分对于冠心病诊断的应用价值。方法选择2013年8月至2015年8月在该院收治的35例冠心病患者作为观察组,另选择同期收治的35例非冠心病患者作为对照组。两组患者均行16层螺旋CT冠状动脉钙化积分检查,观察两组患者冠状动脉各分支钙化积分及总积分情况,并比较两组患者冠状动脉钙化情况。结果观察组右冠状动脉、左前降支、左回旋支、左主干及总钙化积分均显著高于对照组(P0.05)。血管钙化程度比较:观察组重度钙化百分比最高(88.57%);对照组无钙化者百分比最高(77.14%);观察组无钙化、少量钙化患者百分比显著少于对照组,差异有统计学意义(P0.05)。观察组重度钙化者百分比显著高于对照组,差异有统计学意义(P0.05)。结论 16层螺旋CT冠状动脉钙化积分有助于明确冠心病患者钙化程度,临床诊断价值较高,适用于冠心病的筛查和诊断。     

腔内CT密度值用于评估冠状动脉钙化及狭窄程度

目的观察冠状动脉CT成像(CCTA)中,根据冠状动脉钙化(CAC)近端与远端冠状动脉管腔CT值及校正后冠状动脉强化值(CCO)差值评估钙化部位管腔狭窄的准确度。方法对CCTA显示钙化的233支主要冠状动脉(左前降支、左回旋支和右冠状动脉),根据狭窄程度分为轻度狭窄组、中度狭窄组、重度狭窄组和完全闭塞组,比较各组CCO差值,分析以钙化近远端CCO差值评估冠状动脉狭窄的准确度。结果完全闭塞组CCO差值高于轻度狭窄组、中度狭窄组和重度狭窄组(P<0.001);重度狭窄组与中度狭窄组CCO差值差异无统计学意义(P>0.05);中度狭窄组和重度狭窄组CCO差值高于轻度狭窄组(P<0.001)。以钙化近远侧CCO差值0.0869作为诊断界点,其诊断冠状动脉≥50%狭窄的敏感度、特异度、阳性预测值和阴性预测值分别为76.67%、75.47%、91.39%和48.78%;以0.2070作为诊断界点时,其诊断冠状动脉闭塞的敏感度、特异度、阳性预测值和阴性预测值分别为91.84%、79.89%、54.88%和97.35%。结论冠状动脉钙化近远端管腔CCO差值随狭窄程度加重而升高,以之作为评价指标,可明显提高评估冠状动脉钙化及狭窄程度的准确性。     

A giant aneurysm of the circumflex coronary artery with fistulous connection to the coronary sinus: a case report

Non-atherosclerotic coronary artery aneurysms are rare and most of them remain asymptomatic. We report a case who has a giant circumflex coronary artery aneurysm with fistulisation into the coronary sinus. The patient presents with dyspnea and palpitation due to atrial fibrillation with rapid ventricular response. The diagnostic contributions of echocardiography, coronary angiography are discussed. The hemodynamic effects of this anomaly are reviewed.     

超声心动图诊断川崎病冠状动脉病变的价值

目的：评价超声心动图诊断川崎病状动脉病变的价值。方法：对29例川崎病的冠状动脉病变进行超声检查。结果：研究发现川崎病冠状动脉病变表现分为4种。冠状动脉正常、冠状动脉扩张、冠状动脉瘤及巨大冠状动脉瘤、以冠状动脉扩张为主,对临床诊断和治疗提供帮助,结论：超声心动图是诊断川崎病冠状动脉病变的首选方法。     

新一代国产冠脉液电冲击波球囊导管应用于重度冠脉钙化病变的初步尝试

目的：探讨新一代国产冠脉液电冲击波球囊导管治疗重度冠脉钙化病变的有效性和安全性。 方法：收集3例重度冠脉钙化病变患者，应用Sonico-CX冠脉液电冲击波球囊导管对钙化病变进行预处理，以4atm充盈扩张后释放10个脉冲后，再加压至8atm*10秒扩张，同一钙化部位重复2-4次。 结果：国产冠脉液电冲击波球囊导管均能有效扩张重度冠脉钙化病变，有助于后续支架植入，围手术期未出现任何手术并发症。 结论：国产冠脉液电冲击波球囊导管具有操作简单、疗效确切、安全性高的特点，可作为重度冠脉钙化病变的治疗选择。     

Aneurysm involving bifurcation of left main coronary artery presenting with transient ischemic attack, paroxysmal atrial fibrillation and ventricular tachycardia

Coronary artery aneurysm, especially left main coronary artery (LMCA) aneurysm is a rare phenomenon. The disease may be congenital or acquired. The most common cause of coronary artery aneurysm is atherosclerosis. We presented a man with a large LMCA aneurysm presenting with unstable angina, transient ischemic attack, ventricular tachycardia and paroxysmal atrial fibrillation.     

Prenatal diagnosis of a right coronary artery to right atrial fistula with a giant coronary artery aneurysm: A case report

Coronary artery fistula (CAF) is a rare cardiac anomaly. Here, we diagnosed a right coronary artery-right atrium fistula with giant coronary artery aneurysm (CAA) via fetal echocardiography at 35 weeks' gestation. An urgent caesarean delivery was performed at 36 weeks' gestation because CAA caused mitral obstruction, and fetal atrial flutter was present. Following delivery, we performed aneurysm ligation because the new-born developed atrial tachycardia. The intraoperative findings confirmed the sonographic findings. To the best of our knowledge, prenatal ultrasound diagnosis of CAF and giant CAA has not been reported in the literature. We focus on the ultrasonic characteristics and differential diagnosis in this literature.     

中青年和老年疑似冠心病患者冠状动脉病变特点比较

目的 应用256排冠状动脉CT分析中青年和老年疑似冠心病患者冠状动脉病变特点。方法 2018年6月至2018年11月因疑诊冠心病在保定市第一中心医院就诊并行冠状动脉CT检查为冠状动脉病变的患者972例。根据年龄分为中青年组（<60岁,528例）和老年组（≥60岁,444例）,比较两组危险因素及冠状动脉病变特点。结果 中青年组男性比例、体重指数（BMI）、吸烟、三酰甘油（TG）水平明显高于老年组;老年组高血压比例明显高于中青年组（P<0.05）。老年组钙化斑块及混合斑块所占比例高于中青年组（均P<0.01）。中青年组主要为单支,低钙化积分病变,而老年组主要为多支,高钙化积分病变。Logistic回归分析显示中青年组高钙化积分的独立危险因素依次为吸烟、高血压、糖尿病,而老年组高钙化积分的独立危险因素依次为糖尿病、性别构成。结论 不同年龄段的冠状动脉病变特点有其自身的临床特征。     

Acute coronary syndrome in a young woman with a giant coronary aneurysm and mitral valve prolapse: a case report and literature review

Acute coronary syndrome in the young population is infrequently seen and has a different etiology from that in the elderly population. Giant coronary artery aneurysms are rare and usually asymptomatic, but they can cause acute clinical symptoms such as chest pain or chest tightness. We herein describe a young woman with a history of mitral valve prolapse who developed sudden-onset chest pain. She had mild elevations of her creatine kinase and cardiac troponin levels; however, no ST segment alteration was found on an electrocardiogram, and no abnormal regional wall movement was noted on echocardiography. Cardiac magnetic resonance imaging with late gadolinium enhancement revealed a “mass” at the right coronary artery and linear subendocardial enhancement at the posterior wall. Coronary angiography later confirmed a giant coronary aneurysm with a substantial thrombus. The combined presence of the coronary artery aneurysm and mitral valve prolapse in this patient was likely a sequela of Kawasaki disease.     

Evaluation of subclinical coronary atherosclerosis in mild asymptomatic primary hyperparathyroidism patients

Objective Although there is sufficient data supporting the increased cardiovascular risk in patients with advanced stage of primary hyperparathyroidism (pHPT), it is not clear whether same is valid for patients with subclinical forms of this disease. In this study we aimed to evaluate coronary atherosclerosis burden of asymptomatic pHPT patients by using tomographic coronary calcification scoring. Patients and methods Thirty-one mild asymptomatic pHPT patients (28 female, 3 male; mean age: 54.4 ± 12.1 years) and 19 gender- and age-matched normotensive healthy controls (17 female, 2 male; mean age: 50.6 ± 5.8) constituted our study population. Asymptomatic pHPT patients were subdivided according to presence of hypertension (19 hypertensive and 12 non-hypertensive patients). All subjects in study population underwent tomographic coronary calcification scoring by using 16-multidetector computed tomography (16-MDCT). Results Median tomographic coronary calcification score was comparable between the whole group of pHPT patients [0.0 (Interquartile Range, IQR:18.70] and the controls [0.0 (IQR: 0.90). Median tomographic coronary calcification scores of pHPT patients with hypertension was 0.90 (IQR: 75.0) HU, whereas no calcification was noted in coronary arteries of normotensive pHPT patients. Calcification scores of hypertensive pHPT patients were significantly higher than both normotensive pHPT patients (P = 0.014) and controls (P = 0.046). There was no significant difference regarding calcification scores of normotensive pHPT patients versus controls. In the binary logistic regression model, only the presence of hyperlipidemia was found to be independently associated with presence of calcification on coronary arteries (relative risk 6.56, 95% CI 1.18–36.56, P = 0.032). Conclusion These results suggest that mild asymptomatic pHPT with serum calcium levels in the high-normal range does not constitute an independent risk factor for coronary atherosclerosis. The combined presence of classic cardiovascular risk factors determines the severity of coronary atherosclerosis in these patients.     

Successful nitinol stent implantation in a large coronary aneurysm: post-interventional patency assessment by magnetic resonance imaging

Nitinol stents are thought to exhibit reduced occurrence of artifacts and may be suitable for magnetic resonance imaging (MRI) evaluation of stent localization and in-stent patency even in coronary-sized stent grafts. A 54-year-old male patient presented with a large coronary post-stenotic aneurysm of the right coronary artery (RCA) beside significant stenoses of the left circumflex coronary artery (LCX) and the left anterior descending coronary artery (LAD) with aneurysm formation. After implantation of stent grafts to the LAD and LCX, two polymermembrane-covered nitinol stent grafts were placed into the RCA. A control MR examination 7 days following the RCA intervention showed successful occlusion of the former aneurysm, no post-interventional endoleak, and bright signal within the stent indicating stent patency. Thus, coronary MRI after nitinol stent implantation in coronary aneurysms is feasible for post-interventional early imaging control at least as far as the exclusion of possible endoleaks is concerned.     

双源CT诊断川崎病冠状动脉病变

目的 探讨双源CT(DSCT)诊断川崎病冠状动脉病变的临床应用价值。方法 对16例川崎病冠状动脉病变患者进行DSCT冠状动脉成像,将获得的数据进行容积再现(VR)、多平面重建(MPR)、最大密度投影(MIP)、曲面重建(CPR),观察冠状动脉病变的部位、数目、形态和大小,并和同期超声心动图(ECHO) 进行比较分析。结果 16例川崎病患者共累及22支血管,表现为单纯性冠状动脉扩张4例、单纯性冠状动脉狭窄2例、冠状动脉瘤10例(共28个),其中2例冠状动脉瘤伴钙化、4例冠状动脉瘤伴冠状动脉扩张。ECHO未显示的病变为小冠状动脉瘤4个(右冠状动脉远段2个、左前降支远段及左回旋支中段各1个)、冠状动脉钙化2例、冠状动脉狭窄1例、冠状动脉轻度扩张1例。结论 DSCT能清晰全面显示冠状动脉病变及程度,是川崎病冠状动脉病变患儿诊断和随访的重要评估方法。     

Suspected coronary ostium calcification identified as a protruding stent by epiaortic echography

A 76‐year‐old male patient was admitted for mitral valvuloplasty. He had suffered a myocardial infarction 7 months earlier, and two stents had been inserted in the left main coronary artery and left circumflex artery. Intraoperative transesophageal echocardiography revealed a 10 × 8 mm echogenic mass at the ostium of the left main coronary artery. We initially suspected severe atheromatous calcification at the coronary ostium, which might require aortotomy and removal, but we decided to perform an epiaortic ultrasonographic scan first to obtain better images and reevaluate. Epiaortic scanning with a linear sonographic probe identified the mass as a protruding coronary stent. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound, 43 :135–137, 2015     

彩色多普勒超声诊断右冠状动脉右房瘘合并右房内冠状动脉瘤1例

正患者男,28岁,因心悸于外院超声检查发现右房基底部于上腔静脉入口处见44 mm×41 mm囊性无回声区。经我院心脏超声心动图检查:全心大,右冠状动脉扩张(图1),根部宽约20 mm,自前向后上走行至右房顶部,进入右房内形成局部较大瘤样回声,大小约43 mm×41 mm;CDFI示主动脉内血流自主动脉右窦经右冠状动脉瘘入右房,在右房内形成瘤样扩张,其内形成环状     

64排CT冠状动脉成像诊断冠状动脉狭窄的临床价值

目的 评价64排CT冠状动脉成像(CTCA)技术诊断冠状动脉显著狭窄(≥50%管腔狭窄)的临床价值.方法 采用CTCA对61例临床疑诊冠心病患者进行检查,并于CTCA检查后2周内行选择性冠状动脉造影(SCA).结果 1例患者因冠状动脉严重钙化4支血管CTCA不可评估,其余60例患者240支冠状动脉血管CTCA均可良好显影,240支血管显著狭窄诊断的灵敏度、特异度、阳性预测值及阴性预测值分别为90.0%(72/80)、91.9%(147/160)、84.7%(72/85)、94.8%(147/155).结论 CTCA显示了较高的阴性预测值,可以作为排除冠状动脉显著病变的一种无创标准性检查.     

Quantification of coronary artery calcification in patients with FH using EBCT

BACKGROUND: Calcification of the coronary vessel wall is regarded as a marker of advanced coronary atherosclerosis. METHODS: To test whether patients with heterozygous familial hypercholesterolemia (FH) exhibit excessive calcification of the coronary vessel wall, we quantified coronary artery calcium in LDL-apheresis treated FH-patients with known severe coronary artery disease (CAD) (n = 10), in patients with moderate hypercholesterolemia and known severe CAD (n = 10), and in asymptomatic controls (n = 10) using electronic beam CT. The total coronary calcium score (Agatston-Score), the number of calcified lesions and the calcified plaque volume were evaluated for this study. RESULTS: CAD-patients with FH, although on average 10 years younger, had a significantly higher total coronary calcium score (702/2018/2890), number of lesions (34/43/49) and calcified plaque volume (700/1818/2313) compared to patients with CAD only (480/641/1362, 10/16.5/22, 480/588/1209, respectively) and controls (10/47/137, 2/4/10, 15/50/144, respectively). Furthermore, we observed a significant correlation (r = 0.93; P < 0.01) between LDL-cholesterol levels (pretreatment levels of the CAD-FH group) and the total coronary calcium score in all three groups. Our results demonstrate that coronary artery calcification is more extensive in CAD-patients with FH than in CAD-patients with moderate hypercholesterolemia. In addition, we provide evidence that the amount of calcium in the coronary vessel wall in FH patients result from a long lasting history of elevated LDL-Cholesterol levels. CONCLUSION: These findings emphasize the significance of LDL-cholesterol as a risk factor for atherosclerosis and underline the importance of early diagnosis of CAD and early cholesterol lowering therapy in FH patients.     

老年冠心病患者血管内皮功能、颈动脉内中膜厚度、冠状动脉钙化积分变化的研究

目的探讨老年冠心病患者的血管内皮功能、颈动脉内中膜厚度及斑块、冠状动脉钙化积分的变化及相互关系.方法对30例老年冠心病组,24例无冠心病老年对照组采用高分辨超声检测肱动脉基础动脉内径(D0)、内皮依赖性血流介导的舒张功能(FMD)、非内皮依赖性硝酸甘油介导的舒张功能(NID),颈动脉超声检测颈动脉内中膜厚度(IMTc)及斑块,螺旋CT检测各冠状动脉钙化积分(CS)及冠脉总钙化积分(TCS).结果冠心病组的FMD、NID低于对照组(P<0.001), D0两组差别无统计学意义(P>0.05);IMTc、CS及TCS明显高于对照组(P<0.01),颈动脉多发性硬斑发生率高于对照组(P<0.01).IMTc与CS、TCS呈正相关(P<0.01),IMTc、CS、TCS与FMD、NID呈负相关(P<0.01).结论老年冠心病患者存在较严重的血管内皮功能失调、颈动脉粥样硬化及冠状动脉钙化.肱动脉舒张功能、颈动脉内中膜厚度及斑块、冠状动脉钙化积分的测定对冠心病的预测和防治具有重要意义.     

16层CT冠状动脉成像与选择性冠状动脉造影的对比研究

目的:探讨16层CT对冠状动脉粥样硬化病变的显示情况及临床价值。方法:39例患者进行16层CT冠状动脉造影检查(疑似冠心病者31例,PTCA术后8例)及选择性冠状动脉造影。分析16层CT对冠状动脉各节段的显示情况。以管腔直径减小>50%为标准,判定冠状动脉狭窄。分析16层CT诊断冠状动脉狭窄的敏感性、特异性及符合率,及对病变性质的显示情况。结果:16层CT对冠状动脉的总体显示率为94.8%(333/351)。评价冠状动脉病变的总体敏感性为82.2%,特异性为94.7%,符合率为86.0%。16层CT显示钙化及非钙化斑块混合存在致血管狭窄21处,高估3处;中间密度斑块致狭窄8处,高估3处;软斑块3处,无显著狭窄。16层CT能清晰显示支架位置、形态及远端血流,1例再狭窄,1例闭塞,余通畅,其结果与选择性冠状动脉造影一致。另外,16层CT显示冠状动脉起源变异2例,前降支冠状动脉瘤1例,室壁瘤1例,房间隔缺损1例。结论:16层CT冠状动脉成像是一种颇具潜力的无创性检查方法,能够较为准确、全面的评价冠状动脉病变。     

A case of coronary-pulmonary artery fistula with coronary artery aneurysm detected for Kawasaki disease remote phase

Follow-up echocardiography showed two coronary-pulmonary artery fistulae and a coronary artery aneurysm in a 12-year-old boy who had been diagnosed with Kawasaki disease without persistent coronary artery lesion at the acute phase when he was 6-months-old. Left coronary arteriogram confirmed the fistulae and the 4.3 × 6.3 mm aneurysm. Results show that the fistula is associated with Kawasaki disease.