右冠状动脉开口异位1例

在局部解剖的过程中,发现右冠状动脉开口位置异常1例(附图),报道如下:下,动脉口直径为0.4cm,其主干先在升主动脉根部与肺动脉干之间紧贴升主动脉壁向右行走0.9cm距离,继行于肺动脉与右心耳下方的右冠状沟内,向右绕过右缘至膈面走行于后室间沟,于心尖处与前室间支末梢吻合,沿途分支有:右圆锥支、右室支、右缘支、右房支、房事结支。左冠状动脉开口于左主动脉窦内,动脉口直径为0.4cm,心脏其它部位未见异常。 本例右冠状动脉分支和分布虽属正常,但其始段贴着升主动脉壁行走,当主动脉充盈扩张时,可能影响到右冠状动     

冠状动脉解剖变异及其狭窄病变的介入治疗

目的　分析国人冠状动脉解剖变异情况及检出率,总结对起源异常的冠状动脉狭窄行介入治疗的体会。 方法　回顾性总结2010年在我中心接受冠状动脉造影检查的3015例患者,分析42例解剖异常的冠状动脉,总结5例起源异常合并狭窄冠状动脉的经皮冠状动脉介入治疗（PCI）。 结果　3015例冠状动脉造影（CAG）患者中检出解剖变异占1.39%（42例）,其中冠状动脉起源异常占0.93%（28例）,冠状动脉肺动脉瘘占0.27%（8例）,冠状动脉左室瘘占0.07%（2例）,冠状动脉右室瘘占0.07%（2例）,冠状动脉左房瘘占0.03%（1例）,冠状动静脉瘘占0.03%（1例）。5例行PCI手术,4例成功,1例术中放弃,未发生严重并发症。 结论　对起源异常冠状动脉合并狭窄病变进行PCI是安全可行的。     

双源CT冠脉成像对冠状动脉畸形的诊断价值

目的：探讨双源CT（DSCT）冠脉成像在冠状动脉畸形（CAA）诊断中的价值。方法：回顾分析357例经DSCT冠脉成像检出的冠状动脉畸形患者的MPR、VR、MIP及CPR图像,其中31例患者的图像与常规冠状动脉血管造影（CAG）进行对照。结果：DSCT冠脉成像检出的357例冠状动脉畸形中,冠状动脉起源异常37例,包括冠状动脉高位起源15例,冠状动脉起源于对侧冠状窦13例,回旋支起自左冠状窦7例,回旋支起自右冠状窦1例,单一冠状动脉1例;本组冠状动脉走行异常均表现为心肌桥（MB）,其发现MB319例326处;冠状动脉终止异常中冠状动脉瘘1例。其中31例于DSCT冠脉造影后行CAG检查,DSCT冠脉成像检出27例29处MB者CAG仅检出21例22处,但3例冠状动脉起源异常及1例冠状动脉瘘行CAG全部检出。结论：DSCT冠脉成像能清晰地显示各种冠状动脉畸形,为术前评估及预后判断提供重要信息,亦可作为随诊复查的可靠方法。     

《解剖学杂志》投稿须知

正常心是从左心室发出主动脉,右心室发出肺动脉.永存动脉干是指左、右心室均向一根共同的动脉干射血,动脉干的半月瓣骑跨于高位室间隔缺损之上,解剖上仅见总干,未见闭锁的主、肺动脉的遗迹,体循环、肺循环和冠状动脉循环血供均直接来自动脉干.在解剖1例引产畸形胎儿时,发现了一些和常规永存动脉干不同的地方,情况如下.     

单左冠状动脉1例

作者在解剖教学一成年男尸心脏时,发现其右冠状动脉缺如,仅有左冠状动脉,现报道如下:找寻右冠状动脉时,于主动脉右窦处未见右冠状动脉开口,但发现在右心耳与肺动脉之间有细小的动脉,于是沿左冠状动脉旋支的走行进行追踪.在冠状沟近房室交点处,旋支发出2支分布于右冠状动脉供血区(图1):一支走行在后室间沟内,另一支沿冠状沟右行,沿途发出分支分布到心右缘、右心室等处,其终末支变细走行于右心耳与肺动脉之间(图2).由于右冠状动脉缺如,旋支走行遥远而部分代替了右冠状动脉血供,因此左冠状动脉旋支代偿性增粗.     

冠状动脉的起源与意义

目的 观察中国人冠状动脉开口的变异情况,为临床冠状血管造影和介入术提供解剖学参考。 方法 选择 55例保存完好的心脏标本,探查每例标本的主动脉窦,观察各个窦中冠状动脉开口的数目和位置,测量从窦底分别到瓣尖、冠状动脉开口以及窦管交界的高度,并对所得结果进行记录和分析。 结果 主动脉窦中冠状动脉开口总数为2～5个不等,多数情况下右冠状动脉开口于主动脉右窦,回旋支和左冠状动脉合并开口于主动脉左窦,肺动脉窦或主动脉后窦中未发现开口。大多数开口位于窦管交界以下（94.5%）和瓣尖上缘以上（80%）,5例标本存在高位开口,即开口位置高于窦管交界。 结论 多数冠状动脉开口的位置在主动脉右窦和主动脉左窦内,瓣尖之上,窦管交界之下。一些变异比如多开口、纵向或环向的位置偏移及裂隙状开口会对解释图像带来困难,对临床进行血管造影、血管成形术、冠状动脉旁路移植术等操作造成不利影响。     

主动脉弓畸形及其临床意义

目的研究主有及其临床意义。方法：在历时１５年对３２０例主动脉弓的解剖中,发现４例主动脉弓畸形,并对此弓变形及其周围诸结构进行解剖和观察。结果：在４例主动脉弓畸形的病例,,２例为右食管后锁骨下动脉并存右非喉返神经,另２例为右主工存左食管后锁骨下一左背主动脉分离。食管后锁上动脉起始部形成憩中产生食管受压性咽下困难,左锁骨下动脉或左背主动脉经支汛管连接或发自左肺动脉,可形成先天性肺动脉一锁骨下动脉窃血症     

左右冠状动脉升主动脉左前壁共同开口1例

冠状动脉畸形(coronary artery anomalies,CAA)是一种先天性疾病,发病率较低,一般认为是在胚胎时期冠状动脉异常发育或未能发育完全造成的。多数冠状动脉畸形患者无临床症状,往往在冠脉造影中偶然被发现。本文回顾了左右冠状动脉共同开口于升主动脉左前壁1例,现报道如下。     

伴异常冠状动脉法乐四联症右室双出口的外科治疗

目的：总结法乐四联症和右室双出口合并冠状动脉畸形手术治疗经验，探讨冠状动脉畸形对右室流出道重建的影响。方法：自1989年4月至2004年5月治疗合并冠状动脉畸形的法乐四联症和右室双出口20例，其中单支冠状动脉畸形11例，左前降支起自右冠状动脉6例，右冠状动脉-肺动脉瘘2例，左右冠状动脉交通支形成蔓状血管丛1例。行姑息手术1例，根治术19例。结果：根治术早期死亡1例，18例随访10个月至8年，残余漏2例，残余梗阻3例，余结果满意。结论：根据畸形冠状动脉走行特点，选择手术切口，避免损伤异常冠状动脉。     

胎儿肺动脉起源异常8例尸体解剖分析

目的 对胎儿先天性肺动脉起源异常进行分析,提高该疾病诊断的精准性。方法 回顾性分析8例胎儿先天性心脏畸形病例,均经尸体解剖证实,检查胎儿心血管畸形及内脏的畸形情况,对肺动脉异位起源进行分析总结。结果 肺动脉异位起源8例,其中男胎4例,女胎4例,孕期为孕21～28周。右肺动脉起自升主动脉1例,同时存在主-肺动脉间隔缺损、主动脉弓离断并室间隔完整,即Berry综合征。双侧肺动脉融合起自左头臂干1例,患者伴肺动脉闭锁等多种心血管畸形及心外脏器畸形。左肺动脉和右肺动脉分别起自不同主动脉或分支3例,均伴随肺动脉闭锁,1例左肺动脉起自左头臂干,右肺动脉起自降主动脉及右侧动脉导管;1例左肺动脉起自右动脉导管,右肺动脉起自右锁骨下动脉;1例左肺动脉起自左动脉导管,右肺动脉起自降主动脉。左肺动脉吊带3例,肺动脉主干发出右肺动脉,右肺动脉发出左肺动脉形成血管环。结论 胎儿肺动脉异位起源是一种少见血管畸形,其走行复杂多样,可伴随心内畸形及心外脏器畸形。     

Variant of the left coronary artery with an unusual origin and course: Anatomic and postmortem angiographic findings

This study demonstrates anatomic and postmortem angiographic findings characterizing the origin of the left coronary (LC) artery arising in common trunk with the right coronary (RC) artery from the right aortic sinus and its course via the ventricular septum (VS) to the left heart. This anomaly was a single finding observed among 388 angiographies and 60 corrosion castings. The course of the LC was divided in four segments. The first three form a curve that is upward concave. Large branches to the septomarginal trabecula (ST), VS, diagonals (DS), and the small anterior interventricular (anterior descending) artery originated from the outer part of this curve. In the anteroposterior x-ray, the above curve resembles a deep-bottom pot with a handle corresponding to the fourth segment. In the right anterior oblique, the first and second segments form a large erect angle. The third segment occupies the lower part of the absent proximal anterior interventricular artery, and the fourth crosses the outflow tract and the first segment in the middle. The course of these four segments of LC resembles the shape of the number 6. These findings are important for interpreting coronary angiographies in patients with this anomaly. Clin. Anat. 11:367–371, 1998. © 1998 Wiley-Liss, Inc.     

Changes in Coronary Perfusion after Occlusion of Coronary Arteries in Kawasaki Disease

Purpose

Myocardial infarction in children with total occlusion of a coronary artery after Kawasaki disease is rare due to multiple collateral vessels. We aimed to investigate the changes in coronary perfusion associated with coronary artery occlusion after Kawasaki disease.

Materials and Methods

Eleven patients with coronary artery occlusion after Kawasaki disease were investigated. Serial coronary angiographies after total occlusion of a coronary artery were reviewed and the changes were described in all patients with additive information collected.

Results

The median age at the occlusion was 5.9 years old. The interval to occlusion was 6.2±6.9 years. Four left anterior descending coronary artery total occlusions and 10 right coronary artery total occlusions were detected. Immediate coronary artery bypass graft for left anterior descending coronary artery total occlusion made right coronary total occlusion occurred in all except one patient and the intervals thereof were 1 year, 1.8 years, and 4 years. Collaterals to the left coronary artery regressed after recanalization, while new collaterals to the right coronary artery developed. In three, collaterals to the right coronary artery decreased without recanalization without clinical signs.

Conclusion

The right coronary artery should be followed up carefully because of possible occlusion of new onset or changes in collaterals.     

Rapid progression of nonculprit coronary lesions six weeks after successful primary PCI in culprit artery： a case report

We report a case of a 49-year-old man who was admitted with a 3-hour history of sudden onset of substemal chest pain. Coronary angiography revealed that the left circumflex artery （LCX） was acutely and totally occluded at the mid-portion. In addition, the proximal and mid-portion of the right coronary artery （RCA） had a 60% occlusion. We inferred that the LCX was the culprit artery and primary PCI was successfully performed. Six weeks later, the patient had an eventful course with recurrence of chest pain. Coronary angiography showed no significant ste- nosis in the previous LCX lesion, while the proximal and middle potion of the RCA had a 90% occlusion. Our case demonstrates the systemic nature of acute coronary syndromes and highlights the inherent instability of coronary artery disease.     

冠脉CT与冠脉造影诊断心肌桥的临床价值比较

目的:比较冠脉CT与冠脉造影诊断心肌桥的临床价值。方法:收集2015年7月~2020年7月苏州大学第二附属医院心内科收治的107例疑似冠心病患者临床资料。依次进行冠脉CT和冠脉造影检查,计算壁冠状动脉（MCA）狭窄程度,观察前降支、对角支、钝缘支、后降支和回旋支冠脉分布走行以及与心肌的关系,测量心肌桥长度和厚度。比较两种检查方法图像质量优良率、心肌桥检出率以及心肌桥测量指标。分析两种检查方法显示MCA狭窄程度和诊断心肌桥的一致性。以冠脉造影为金标准,计算敏感度、特异度、准确度、阳性预测值、阴性预测值,评估冠脉CT判断MCA中重度狭窄和诊断心肌桥的价值。结果:两种检查方法图像质量优良率均较好,冠脉CT心肌桥检出率显著高于冠脉造影（25.23% vs 14.02%, P<0.05）;冠脉CT测得心肌桥长度大于冠脉造影,MCA狭窄程度低于冠脉造影,差异具有统计学意义（P<0.05）;冠脉CT和冠脉造影显示MCA狭窄程度的一致性较好（Kappa=0.832, P<0.05）;与冠脉造影比较,冠脉CT判断MCA中重度狭窄的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为90.63%、86.67%、74.36%、95.59%、87.85%;冠脉CT和冠脉造影诊断心肌桥的一致性较好（Kappa=0.815, P<0.05）;与冠脉造影比较,冠脉CT诊断心肌桥的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为64.29%、73.33%、69.23%、68.75%、68.97%。结论:冠脉CT与冠脉造影对心肌桥诊断均具有一定价值,而冠脉CT具有无创性、图像质量优良率高,且对心肌桥位置及分布显示佳,并对MCA狭窄具有较高敏感度和特异度,更具临床应用优势。     

Animal models of coronary heart disease

Cardiovascular disease, predominantly coronary heart disease and stroke, leads to high morbidity and mortality not only in developed worlds but also in underdeveloped regions. The dominant pathologic foundation for cardiovascular disease is atherosclerosis and, as to coronary heart disease, coronary atherosclerosis and resulting lumen stenosis, even total occlusions. In translational research, several animals, such as mice, rabbits and pigs, have been used as disease models of human atherosclerosis and related cardiovascular disorders. However, coronary lesions are either naturally rare or hard to be fast induced in these models, hence, coronary heart disease induction mostly relies on surgical or pharmaceutical interventions with no or limited primary coronary lesions, thus unrepresentative of human coronary heart disease progression and pathology. In this review, we describe the progress of animal models of coronary heart disease following either spontaneous or diet accelerated coronary lesions.     

Giant coronary sinus aneurysm secondary to right coronary arteriovenous fistula leading to pseudo-mitral stenosis

We herein report a case in which a right coronary to coronary sinus arteriovenous fistula determined progressive aneurysmatic dilatation of the coronary sinus. Severe compression of the left atrium ensued. This led to a clinical and instrumental picture similar to that observed in severe mitral stenosis.     

Comparing mortality and myocardial infarction between coronary artery bypass grafting and drug-eluting stenting in patients with diabetes mellitus and multivessel coronary artery disease: a meta-analysis

Introduction

We aim to compare the midterm outcomes between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in diabetic patients who had multivessel coronary artery diseases (CAD).

Material and methods

A comprehensive literature search was conducted to identify the related clinical studies with a follow-up for 1 year at least. The endpoints were death, myocardial infarction, and major adverse cardiac and cerebrovascular events (MACCE).

Results

Finally, the analysis of ten studies involving 5,264 patients showed that patients with CABG had worse baseline characteristics, a higher rate of stable angina pectoris, a higher percentage of triple-vessel disease, higher incidence of chronic total occlusion and a higher SYNTAX score. However, there was no significant difference in mortality between the two groups. Additionally, the rates of myocardial infarction and MACCE were markedly decreased in the CABG group.

Conclusions

The strategy of CABG is better than PCI for diabetic patients with multivessel CAD. The CABG can significantly reduce the rates of myocardial infarction and MACCE and is comparable in mortality despite the worse baseline characteristics.     

右冠状动脉起源于左主干5例临床分析

目的：分析右冠状动脉起源于左主干的临床特征，探讨其与心肌缺血的关系。方法：回顾分析5例右冠状动脉起源于左主干的临床资料及相关文献。结果：（1）本组5例患者中，女性1例，男性4例，年龄27～70岁。（2）临床表现主要为胸痛、胸闷等心绞痛症状，除1例老年患者外，其余4例病人都有典型的心绞痛症状和缺血心电图变化。（3）冠状动脉造影示3例合并严重冠状动脉粥样硬化，给予冠状动脉搭桥术，术后随访2月～6年无明显不适；另2例冠状动脉无明显病变，药物治疗后仍有劳累性心绞痛发作，其中1例半年后猝死。结论：右冠状动脉起源于左主干是一种罕见的冠脉畸形，对存在严重心肌缺血的患者应进行预防性冠状动脉搭桥术或介入治疗，预防不良事件的发生。     

老年冠心病慢性闭塞病变的介入治疗探讨

目的探讨老年冠心病患者采用经皮冠状动脉介入(PCI)治疗的中短期疗效。方法对102例住院老年患者采用股动脉穿刺后,行球囊扩张,造影显示扩张满意后植入合适支架。术后随访6-32个月。结果102例患者术后临床症状均完全或基本完全缓解。本组患者有19例多支病变患者至少有一支慢性完全闭塞血管经努力而未能开通,无法植入支架。102例患者通过随访6-32个月,其中32例患者接受了冠脉造影复查,有17例患者分别于术后6个月至16个月又出现胸痛、胸闷症状。超声心动图检查射血分数(EF),心功能术后较术前明显改善,P<0.05。结论对冠状动脉慢性完全闭塞的老年患者,无论核素或超声检查是否存在存活心肌,均应尽量进行闭塞病变的介入治疗,以期改善患者的远期预后。     

Is there an additional benefit from coronary revascularization in diabetic patients with acute coronary syndromes or stable angina who are already on optimal medical treatment?

Cardiovascular disease (CVD) is common in patients with diabetes mellitus (DM) and related clinical outcomes are worse compared with non-diabetics. The optimal treatment in diabetic patients with coronary heart disease (CHD) is currently not established. We searched MEDLINE (1975-2010) using the key terms diabetes mellitus, coronary heart disease, revascularization, coronary artery bypass, angioplasty, coronary intervention and medical treatment. Most studies comparing different revascularization procedures in patients with CHD favoured coronary artery bypass graft (CABG) surgery in patients with DM. However, most of this evidence comes from subgroup analyses. Recent evidence suggests that advanced percutaneous coronary intervention (PCI) techniques along with best medical treatment may be non-inferior and more cost-effective compared with CABG. Treatment of vascular risk factors is a key option in terms of improving CVD outcomes in diabetic patients with CHD. The choice between medical therapy and revascularization warrants further assessment.