Primary dissecting aneurysms of the coronary arteries: Case report and literature review

We describe a case of dissecting aneurysm that occurred in a 33-year-old woman suffering from acute myocardial infarction, which was discovered by coronary angiography. Angiographic diagnosis of dissections is rare with only six such cases previously reported. Sixty cases in the literature are reviewed to ascertain the main characteristics of this rare entity. The distinct predominance of this disease among women, particularly post partum, suggests an hormonal influence on its pathogenesis.     

颅外段颈/椎动脉夹层及动脉瘤的介入治疗观察

目的评价介入治疗颅外段颈/椎动脉夹层及动脉瘤的安全性和疗效。方法收集住院病例11例,其中男性7例,女性4例,发病年龄32~54岁,平均年龄(42±5)岁。临床表现:合并高血压者8例;同时合并高血压、糖尿病者3例;合并痛风1例;余3例未发现明显的危险因素。11例患者均在造影同时行血管成形术,包括对狭窄的颈内动脉/椎动脉进行球囊扩张和置放支架。其中7例颈内动脉植入自膨式血管支架9枚,4例椎动脉植入支架4枚。术后均抗血小板、抗凝治疗。术后及出院后随访3~29个月。结果 11例患者介入治疗均获成功,临床症状明显减轻或消失。无并发症及死亡病例。狭窄的动脉血流通畅,内径渐恢复正常,夹层动脉的动脉瘤也明显缩小。术后随访,均未见相关临床症状复发。结论介入治疗颅外段颈/椎动脉夹层及动脉瘤,损伤小、安全、有效。     

Rupture of a subclavian artery aneurysm in a heroin addict

Summary A previously healthy heroin addict died suddenly and unexpectedly of hemothorax due to rupture of a subclavian artery aneurysm. He had been using the neck veins for mainlining. The pathogenesis of the aneurysm is discussed.     

17例四肢创伤性假性动脉瘤的外科治疗

目的 探讨不同类型四肢创伤性假性动脉瘤的外科治疗方法。方法 回顾分析1990年1月—2006年4月收治的创伤性假性动脉瘤17例。，其中14例手术治疗，血肿清除后分别行血管侧壁缝合术7例，端端吻合术1例，人工血管移植术1例，自体血管移植术1例，近远端血管结扎4例。采用非手术治疗局部加压包扎3例。结果 本组患者无死亡或肢体坏死，治疗后临床症状消失。患者平均随访13.2个月，患肢功能良好。 结论 四肢创伤性假性动脉瘤诊断明确后，应根据不同类型采取不同的治疗方法。     

Prevalence and severity of coronary artery calcium in young persons with diabetes

BackgroundCurrently, American Diabetes Association guidelines suggest statin use among persons with diabetes mellitus aged >40 years. The presence of calcified plaque in coronary arteries is a sensitive surrogate of coronary artery disease and has been shown to be an independent predictor of mortality and cardiac events.ObjectiveWe aimed to assess the prevalence and severity of calcified plaque in coronary arteries in patients aged <40 years with and without diabetes.MethodsWe included 3723 asymptomatic patients aged <40 years who had undergone coronary calcium scanning. Clinical and demographic data were collected. Agatston score was categorized into Agatston score 0 as normal, 1 to 99 as low, 100 to 399 as intermediate, and ≥400 as severe; and statistical analysis was performed.ResultsThe study population consisted of 4% persons with diabetes (n = 142) and 56% men with a mean age of 35 ± 5 years. Young persons with diabetes had greater prevalence of Agatston score > 0 than persons without diabetes (43% vs 24%; P < .0001). In addition, 12% of persons with diabetes vs 2.5% of persons without diabetes had an Agatston score ≥ 100 (P < .0001). The prevalence of calcified plaque in coronary arteries was >50% in persons with diabetes aged >35 years. After taking into account risk factors, the presence of diabetes was associated with a 4-fold higher odds of an Agatston score ≥ 100 (odds ratio, 4.19; 95% CI, 2.29–7.65; P < .0001).ConclusionOur study found that 43% of young patients with diabetes have detectable coronary atherosclerosis. Given the known clinical implications of calcified plaque in coronary arteries, future studies are needed to evaluate interventions in persons aged <40 years who exhibit subclinical atherosclerosis to reduce future cardiovascular disease events in this vulnerable population.     

64层螺旋CT血管成像对低龄儿童川崎病冠状动脉病变的随访诊断价值

目的 评价64层螺旋CT(MSCT)对低龄儿童川崎病冠状动脉瘤的随访诊断价值和应用可行性.方法 对12例随访中的川崎病冠状动脉瘤患儿(平均年龄5.2岁,随访时间1.1～5.1 年)进行64层MSCT冠状动脉成像,观察冠状动脉病变的程度和冠状动脉瘤的数目、位置、形态和大小,并和同期超声心动图(ECHO)进行比较分析.结果 MSCT共观察到30个冠状动脉瘤,左、右冠状动脉各15个,肿瘤最宽径为20.6 mm,平均(7.5±3.8)mm;最长径为38.0 mm,平均(124±9.1)mm;10个小冠状动脉瘤,7个中等冠状动脉瘤,13个为巨大瘤;14个圆形,16个梭形.累及左冠状动脉主干7个,前降支近段9个,前降支中段4个,回旋支2个;右冠状动脉近段6个,右冠状动脉中.段9个,右冠状动脉远段4个;其中9个肿瘤累及2个节段,1个累及3个节段.发现6处狭窄,5个瘤壁钙化,3个合并血栓.8个较小或位于中远段的冠状动脉瘤ECHO未能发现.结论 64层MSCT能清晰显示冠状动脉瘤和冠状动脉病变程度,可成为低龄川崎病冠状动脉瘤患儿随访和诊断的重要评估方法.     

1879例成人非先天性心脏病患者双源CT检出的冠状动脉起源异常24例分析

目的：评价双源CT（DSCT）在成人非先天性心脏病患者冠状动脉起源异常检出中的价值。方法：回顾性分析2008年9月,2009年2月期间进行了DSCF冠状动脉检查的资料,总结成人非先天性心脏病患者冠状动脉起源异常的检出率。结果：1881例进行冠状动脉检查的患者中,共有1879例患者为非先天性心脏病患者,共检出了24例冠状动脉起源异常,检出率为1．3％。其中15例为右冠状动脉起源异常（12例起自左冠状窦,3例为高位起源）,8例为左冠状动脉起源异常（3例起自无冠状窦,回旋支起自左冠状窦、高位开口、回旋支起自右冠状动脉、左冠状动脉起自右冠状窦、单一冠状动脉各1例）,1例为左右冠状动脉均起源异常（均为高位开口）。结论：本组成人非先天性心脏病患者冠状动脉起源异常的检出率为1．3％。DSCT可很好地显示冠状动脉起源异常和走行,为临床决策提供重要信息。     

腔内隔绝术治疗胸主动脉夹层(附25例临床分析)

目的 探讨腔内隔绝术治疗胸主动脉夹层的方法和疗效。方法 对25例(年龄42～72岁；男23例，女2例)胸主动脉夹层患者行腔内隔绝术，并进行临床分析和随访，评价其临床改善程度与真假腔的变化。结果 在全麻下25例均成功进行了胸主动脉夹层的血管腔内隔绝术，其中1例为Standford A型，共使用Talent带膜血管支架28个，术中造影证实夹层裂口完全封闭或内漏显著减少，无术中严重并发症及死亡发生，25例随访2～20个月，临床效果良好，假腔内血栓形成。结论 应用带膜血管内支架行腔内隔绝术是治疗胸主动脉夹层安全有效的方法，尤其在亚急性期或慢性期应作为首选的治疗方法。     

双源CT对先天性心脏病儿童冠状动脉成像效果分析

目的 分析儿童先天性心脏病双源CT(DSCT)扫描对冠状动脉显示的效果.方法 2名放射科医师分别对儿童先天性心脏病DSCT扫描的图像评分,按冠状动脉各分支成像效果评为1～4分,3分以上为成像质量较好,可以用于诊断.采用方差分析比较3个心率水平、3个年龄段下冠状动脉评分差异及4支冠状动脉分支间评分差异.采用多元线性回归分析比较各支冠状动脉评分与年龄、心率、管电压、管电流、螺距、对比剂总量、对比剂流率的关系.结果 共评价72例患儿(平均1.5岁),71.2%(205/288)的冠状动脉分支图像质量较好,可以用于诊断.左主干(3.64±0.49)分、前降支(2.97±0.40)分、右冠状动脉(2.82±0.70)分、回旋支(2.76±0.73)分,各支评分依次降低而不完全相同(F=29.00,P<0.01).<1岁组(2.80±0.65)分、≥1～3岁组(2.81±0.74)分、>3～14岁组(3.58±0.52)分,各组评分依次升高而不完全相同(F=20.16,P<0.01).心率<100次/min(bpm)组(3.54±0.56)分,100～150 bpm组(2.86±0.70)分,>150 bpm组(2.81±0.63)分,各组评分依次降低而不完全相同(F=16.72,P<0.01).多元回归分析显示年龄(r=0.013,P<0.01)和对比剂总量(r=0.292,P=0.011)与左主干评分呈正相关;年龄(r=0.509,P<0.01)、管电压与前降支评分呈正相关(r=0.292,P<0.01),心率与前降支评分呈负相关(r=-0.179,P<0.05);年龄与回旋支评分呈负相关(r=0.063,P<0.01);年龄、管电压与右冠状动脉评分呈正相关(r值分别为0.486、0.220,P值分别<0.01、<0.05).结论 DSCT能够清晰显示3岁以上或心率<100 bpm的先天性心脏病儿童的冠状动脉,限制DSCT成像效果的是患儿的基础心律和年龄.     

Varied CT appearance of aneurysms of the vein of Galen in infancy

Summary An aneurysm of the vein of Galen can have a varied CT appearance in infancy. The classical picture is a spherical posterior third ventricular mass with the density of circulating blood contiguous with a dilated straight sinus and with uniform contrast enhancement. With varying degrees of thrombosis of the aneurysm which may occur in late infancy, the mass can change in density and the dilated straight sinus disappear. With total thrombosis, a precontrast hyperdense rim develops with a low density center. The rim enhances but the low density center does not change with contrast infusion. Our experience in three patients with this spectrum of CT findings will be demonstrated and correlated with clinical findings and angiography.The opinions and assertions contained herein are the private views of the authors and must not be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.     

MR detection of quantitative and structural changes in human aortic aneurysms

Collagen is a major component of the extracellular matrix and a determinant of the elastic behavior of the human aorta. To investigate the changes found in aneurysmal degeneration, the authors studied the solid-state hydrogen-1 nuclear magnetic resonance line shape of collagen in aneurysms and normal human aortas. A three-component decomposition of the free induction decay was performed, with collagen characterized by a T2 of about 18 μsec. The second moment of the collagen line shape was found to be increased in aneurysms (5.3 vs 4.8 G²), while, correspondingly, the T2 of collagen was lower in aneurysms (16.3 vs 17.7μsec). This corresponds to a modification of collagen structure and molecular motion. Collagen concentration was lower in nondiseased aortic walls (9.4% vs 7.3%). These results are discussed in reference to the contradictory conclusions in the current literature. The increase in collagen and the modification of its structure and molecular motion are explained by the need to resist an increasing tangential tension due to increased aortic diameter and diminished wall thickness in aneurysms and by intercalation or site binding in the helices or electric dipolar interactions in the less mobile side groups.     

三维增强MR血管造影在主动脉夹层诊断中的价值

目的 评价三维增强MR血管造影（3DCE-MRA）及其三维重建在诊断主动脉夹层中的价值及其临床意义。方法 136例主动脉夹层患者用屏气超快速三维梯度回波序列行3DCE—MRA检查，工作站上三维重建。后处理技术包括容积显示（VR）、多平面重建（MPR）、最大密度投影（MIP）及仿真内镜（VE）。其中，21例行手术治疗，32例因接受腔内隔绝术行DSA造影。结果 （1）136例均能显示明确的真假腔及内膜片，Ⅰ型夹层27例，Ⅱ型2例，Ⅲ型107例。（2）105例可见到明确的初始破裂口。与DSA比较，3DCE—MRA对初始破裂口的显示率为100％，对总体破裂口的显示率为91．4％。初始破裂口以在VR及MPR像上显示为佳，尤其是VR像，可立体显示破裂口形态、大小及与主动脉分支的关系，对手术或血管腔内隔绝术帮助较大。（3）Ⅰ型夹层中，10例（10／27）右无名动脉受累；Ⅲ型夹层中，10．3％（11／107）的左锁骨下动脉受累。腹主动脉分支受累中，32．1％（43／134）的。肾动脉受累，14．9％（20／134）的腹腔动脉干受累；40．3％（54／134）仅累及1支，12．7％（17／134）累及2支或3支。（4）22．8％（31／136）的假腔完全被血栓充填，为主动脉壁内血肿。结论 3DCE-MRA是无创、快速、准确诊断主动脉夹层最有效的影像学检查方法之一，能指导治疗方案的制定，对手术及腔内隔绝术具有较大的帮助。     

64排CT在急性胸痛诊断中的应用价值

目的:探讨64排CT对急性胸痛的诊断价值。方法:63例急性胸痛患者行64排CT回顾性心电门控胸部联合检查。采用MPR、MIP、CPR及VR等显示肺动脉、主动脉、冠状动脉及胸部、胸壁其他组织结构。由2名有经验的放射科医师对所有图像进行分析评价。结果:冠状动脉显影图像质量优占82.0%(672/820),良占12.9%(106/820),差占5.1%(42/820)。全部患者肺动脉和主动脉增强扫描后CT值≥200HU,均能达到诊断要求。心血管源性胸痛50例,其中冠状动脉病变29例,主动脉夹层11例,肺动脉栓塞8例,心包炎2例。非心血管源性胸痛7例,其中气胸3例,胸膜炎2例,肺部感染1例,食管疾病1例。6例未见异常。结论:64排CT胸部血管联合检查能清楚显示肺动脉、主动脉、冠状动脉,图像质量可以满足临床诊断要求,同时还能显示胸部其他疾病,在急性胸痛病因诊断中具有很高的临床应用价值。     

Percutaneous coil embolization in the management of peripheral mycotic aneurysms

Traditional surgical treatment of a peripheral mycotic aneurysm has included emergency ligation and bypass. Occlusion of vessels just proximal and distal to a mycotic aneurysm can be safely accomplished via percutaneous embolization with coils. Surgery can be performed electively in a noninfected field. Coils can be placed near the site of vessel disruption minimizing loss of collateral flow.     

An unusual association of intracranial aneurysms and oesophageal duplication in a case of Klippel-Trenaunay syndrome

The Klippel-Trenaunay syndrome (KTS) is a congenital disorder resulting from a mesodermal abnormality, characterised by cutaneous capillary haemangiomas, hypertrophy of bone and soft tissues and varicose veins. The presence of intracranial aneurysms has rarely been described, while oesophageal duplication has not been reported previously. We describe a patient with the KTS with both there additional abnormalities, which could be explained by a postulated mosaic gene abnormality. Received: 17 December 1999/Accepted: 12 April 2000     

可膨胀水凝胶弹簧圈在颅内动脉瘤急性破裂期栓塞中的应用

目的 探讨可膨胀水凝胶弹簧圈( Hydrocoil)在颅内动脉瘤急性破裂期栓塞中的应用价值.方法 应用Hydrocoil栓塞急性破裂期15例17个颅内动脉瘤,并选择同期应用裸性铂金弹簧圈栓塞的18例颅内动脉瘤进行对比分析.结果经x2检验.结果 Hydrocoil栓塞的17个动脉瘤,致密栓塞16个、大部栓塞1个.裸性铂金弹簧圈栓塞的18例动脉瘤,致密栓塞11例、大部栓塞7例.两者疗效差异有统计学意义(x2=5.402,P＜0.05).患者术后6个月至1.5年内DSA检查,应用Hydrocoil栓塞的患者无复发;应用裸性铂金弹簧圈栓塞的患者动脉瘤复发5例.两者复发率差异有统计学意义(x2 =5.510,P＜0.05).结论 Hydrocoil可提高颅内动脉瘤的致密栓塞程度,并降低颅内动脉瘤栓塞术后的复发率.     

Comparison of coronary artery measurements between echocardiograms and cardiac CT in Kawasaki disease patients with aneurysms

BackgroundAmerican Heart Association (AHA) guidelines for management of Kawasaki disease (KD) rely on coronary artery (CA) z-scores from echocardiograms. Compared with echocardiography, cardiac CT (CCT) offers better visualization of distal segments and evaluation for thrombosis and stenosis. Despite increasing use of CCT in KD, CA z-scores for CCT are not available and measurement concordance between imaging modalities is a critical knowledge gap.MethodsWe retrospectively reviewed KD patients with CA aneurysms who had concurrent echocardiography and CCT between 2016 and 2020. Patients were included if they had history of CA z-scores of ≥3 on echocardiography during their clinical course. Agreement between CCT and echocardiography was assessed using Bland-Altman analysis.ResultsPaired CCT and echocardiography studies were available in 18 patients (21 studies). The largest CA aneurysms were large/giant (z-score ≥10) in 14 studies, medium (z-score ≥5, <10) in 3 studies, and small (z score ≥2.5, <5) in 2 studies. Intra- and inter-observer reliability for CCT measurements were high for all CA segments (ICC 99.7% and 98.6%). For the LMCA, proximal LAD and proximal and distal RCA there was high correlation between echocardiogram and CCT absolute measurements with wider variation between modalities for the distal LAD and circumflex. Overall, CCT measurements tended to be smaller than echocardiogram measurements, and led to a lower AHA z-score risk classification in 24% of studies.ConclusionCCT and echocardiography have high agreement for absolute measurements of proximal CA segments, but more measurement discrepancy exists for distal CA segments with bias toward lower dimensions on CCT.     

128层螺旋CT冠状动脉成像筛查冠状动脉病变的临床价值

目的以选择性冠状动脉造影（SCA）为标准,评价128层螺旋cT冠状动脉血管成像（CTA）诊断冠状动脉疾病（CAD）的临床价值。方法回顾我院52例做过冠状动脉CTA与SCA的冠心病患者,进行对照分析。结果128层螺旋cT冠状动脉CTA可获得较好的图像质量,52例患者中,CTA成像检出心肌桥16例,血管内斑块形成98处;17例一侧明显型优势冠状动脉,冠状动脉狭窄86支,包括轻度狭窄22支、中度狭窄24支、重度狭窄40支,SCA诊断心肌桥6例,冠状动脉狭窄84支,包括轻度狭窄22支、中度狭窄21支、重度狭窄41支。结论冠状动脉CTA与SCA相比,不仅能对冠状动脉粥样硬化的狭窄程度作出判断,还可以对粥样斑块的病理性质、斑块的稳定性以及心肌桥提出明确诊断,可以用于CAD的筛查,几乎能代替诊断性的冠状动脉造影。     

双源CT冠状动脉成像在飞行人员冠心病诊断中的价值

目的 探讨双源CT冠状动脉成像在飞行人员冠心病诊断中的临床应用价值.方法对10名临床怀疑冠心病的飞行人员患者行双源CT冠状动脉成像（computed tomography coronary angiography,CTCA）检查和常规X线冠状动脉血管造影（conventional coronary angiography,CCA）检查,以CCA为金标准比较分析CTCA诊断冠状动脉狭窄的敏感性、特异性及准确性.结果 10例飞行人员患者均成功完成了双源CTCA与CCA 检查,双源CTCA图像优良率为96.3%.CTCA发现不同程度冠状动脉狭窄和斑块形成7例,其中2例同时存在前降支心肌桥;冠状动脉-肺动脉瘘1例;冠状动脉正常2例.7例患者的CTCA图像上15个冠状动脉节段有不同程度狭窄,以CCA为金标准,双源CTCA诊断冠状动脉有狭窄的敏感性、特异性及准确率分别为100.0%、98.2%、98.4%;诊断冠状动脉中度及中度以上狭窄的敏感性、特异性及准确率分别为80.0%、99.2%、98.4%.双源CTCA与CCA显示冠状动脉节段病变的能力无统计学差异（χ2=0.50,P=0.4795）.结论 双源CTCA作为一种无创检查方法,能够准确地评估飞行人员冠状动脉狭窄程度和冠状动脉管壁斑块情况,并能显示冠状动脉先天变异等,对于安全可靠地诊断飞行人员冠心病具有较高的应用价值.     

64层螺旋CT冠状动脉成像在冠心病诊断中的临床分析

目的 评价64层螺旋CT冠状动脉成像在冠心病(CHD)诊断中应用的临床价值.方法 选择52例疑似CHD患者,以上患者均经64层螺旋CT冠状动脉造影检查与选择性冠状动脉造影(CAG)检查,以CAG检查结果为标准,评价64层螺旋CT冠状动脉造影检查的准确性,同时对冠状动脉病变不同部位和狭窄程度的64层螺旋CT冠状动脉造影检查结果进行分析.结果 上述52例疑似CHD患者CT冠状动脉成像检查准确性94.2％(49/53),敏感性95.3％(41/43),特异性88.9％(8/9),阳性预测值97.6％(41/42)和阴性预测值80.0％(8/10);冠状动脉近端血管的检查结果好于冠状动脉远端血管的检查结果;冠状动脉狭窄程度越重的血管其检查结果好于冠状动脉狭窄程度轻的血管的检查结果.结论 CT冠状动脉成像检查无创、安全、快捷和费用低廉,同时具有较高的灵敏性和特异性的特点,可作为CHD高危人群的普查及CHD治疗后的动态随访的检查方法.