右冠状动脉起源异常经桡动脉途径行冠状动脉介入治疗：单中心经验

目的回顾性分析右冠状动脉异常起源于主动脉患者的临床特点、解剖分布规律及冠状动脉介入诊疗过程中的导管选择及技术要点。方法 2009年10月至2014年5月厦门市心脏中心发现右冠状动脉起源异常患者共36例,其中19例行经皮冠状动脉介入治疗（PCI）。36例患者均经桡动脉途径,分析其异常起源情况、术中造影导管选择及技术要点;列举19例行PCI患者的右冠状动脉解剖特点、造影及指引导管选择和术中对比剂用量。结果除1例因头臂干过于迂曲外,其余35例（97.2%,35/36）患者均成功完成选择性冠状动脉造影,19例（52.8%,19/36）行PCI术,除1例慢性完全闭塞病变（CTO）经历二次手术外,余均首次手术成功。35例患者中高位升主动脉偏右侧起源2例[5.7%（2/35,A型],高位升主动脉偏左侧起源3例[8.6%（3/35）,B型],左主干至左窦中线间起源14例[40.0%（14/35）,C型],左冠状窦中线向右冠状窦移行区域起源16例[45.7%（16/35）,D型],其中90%（27/30）C及D型患者使用Tiger造影导管。19例行PCI的患者中A型2例（10.5%,2/19）、B型3例（15.7%,3/19）、C型7例（36.8%,7/19）、D型7例（36.8%,7/19）。A型2例患者使用IL 3.5及MPD指引导管,B型3例使用EBU 3.5及EBU 3.0导管,C型7例及D型7例中分别有6例使用IL 3.5指引导管完成PCI。结论熟悉右冠状动脉异常起源于主动脉的解剖分布规律和相对应的造影及指引导管,有助于提高经桡动脉途径处理该类病变的成功率。     

起源异常的右冠状动脉闭塞病变经皮冠状动脉介入治疗病例报道及文献回顾分析

目的:探讨先天性起源异常的右冠状动脉(冠脉)闭塞病变经皮冠脉介入(PCI)治疗的效果。方法:回顾性分析1例右冠脉起源异常伴心肌梗死患者的诊治经过,并总结近20年来报道的30余例右冠脉起源异常病例,通过对发病率、起源部位、指引导管选择等方面进行探讨。结果:异常右冠脉起源于左冠脉窦的报道较多,应用的指引导管类型以Amplatz、Judkins多见,但病例报道较少。结论:仍需更多的手术经验积累以及对磁共振成像、多排CT等诊断工具的科学应用。     

Judkins Left指引导管在起源异常的右冠状动脉经桡动脉行经皮冠状动脉介入治疗中的应用

目的评价Judkins Left系列指引导管在起源于左冠状窦的右冠状动脉经桡动脉行经皮冠状动脉介入治疗（PCI）中应用的安全性和有效性。方法 11例患者起源于左冠状窦的右冠状动脉存在狭窄或闭塞病变,均采用右侧桡动脉穿刺,选择JL 3.5或JL 4.0指引导管行右冠状动脉PCI,根据病变情况必要时应用双导丝技术或5进6子母导管技术增加指引导管同轴性和支撑力。慢性闭塞病变常规应用微导管增加指引导丝支撑力,以便于更换导丝。观察手术成功率、并发症和近期随访结果。结果 11例患者中,3例为右冠状动脉慢性闭塞病变,8例为严重狭窄病变,同时合并左冠状动脉病变。所有患者均使用Judkins Left系列指引导管经桡动脉成功完成右冠状动脉PCI,7例应用JL 3.5指引导管,4例应用JL 4.0指引导管。2例在Judkins Left系列指引导管基础上应用5进6子母导管,其中包括1例右冠状动脉慢性闭塞病变;4例应用双导丝技术增加支撑力。3例慢性闭塞病变在微导管支持下均成功行PCI,其中1例先应用双导丝技术、后5进6子母导管增强支撑力。所有患者均成功置入药物洗脱支架,共置入支架19枚,每例右冠状动脉置入支架1~3（1.7±0.7）枚,置入支架长度为18~99（44.1±23.8）mm。术中所有患者均未出现冠状动脉穿孔、栓塞或夹层等并发症,手术成功率100%。住院期间无心脏压塞及支架血栓等并发症。术后临床随访6~12个月,无死亡及心肌梗死等不良心血管事件发生。结论对于右冠状动脉起源于左冠状窦病变,经右侧桡动脉途径,可以选择Judkins Left系列指引导管行PCI,支撑力不够时,可辅以其他增加支撑力的技术,如微导管技术、双导丝技术、子母导管技术等完成手术操作。     

经桡动脉入径应用EBU系列指引导管完成右冠状动脉复杂病变的初步经验

目的 探讨应用EBU系列指引导管行右冠状动脉复杂病变介入治疗（ PCI） 的可行性。 方法 前瞻性分析2020年1月至2021年12月首都医科大学附属北京友谊医院及平谷区医院心内科应用EBU指引导管介入治疗右冠状动脉复杂病变25例患者的临床资料、 影像资料和术后恢复情况,对该技术的可行性和安全性进行评价。 结果 25例患者经冠状动脉造影确诊为冠心病,且均存在右冠状动脉复杂病变,有对右冠状动脉行PCI的指征。所有患者均经桡动脉入路使用EBU指引导管行PCI。25例患者的EBU指引导管全部输送到位,经调整进入右冠状动脉开口,EBU导管使用的成功率为100%。25例患者全部行右冠状动脉PCI,24例成功,PCI成功率为96%,无患者出现指引导管相关并发症。结论 经桡动脉应用EBU指引导管行右冠PCI具有很好的可行性和安全性,可作为部分经选择患者行右冠复杂病变PCI的首选方法。     

经远端桡动脉路径行冠状动脉介入诊疗的Meta分析

目的 通过Meta分析评价经远端桡动脉路径行冠状动脉介入诊疗的安全性与有效性.方法 计算机检索 Pubmed、Embase、Web of Science、Cochrane Library、中国生物医学服务系统(Sinomed)、中国知网(CNKI)、万方数据知识服务平台(Wanfang Data)、维普(VIP)等数据...     

右冠状动脉起源异常介入治疗成功1例

1临床资料患者,男性,67岁,以发作性胸闷5d,加重7h入院。既往健康。查体:BP 120/80mmHg,双肺呼吸音正常,HR 75次/min,心律齐,无杂音。腹软,肝脾未触及。双下肢无浮肿。心电图正常,超声心动图示主动脉钙化,左心室收缩功能正常,舒张功能减低。动态心电图示窦性心律,偶发房性期前收缩,未见ST-T缺血改变。胸片及血生化检查正常。入院诊断:冠心病心绞痛。行冠状动脉造影显示左主干正常,前降支近段有钙化,第一对角支中段可见40%狭窄,回旋支近段有钙化,中段有40%狭窄。常规行右冠状动脉(RCA)造影时,先后选用JR4.0和ALⅠ导管造影均未成功。行主…     

经左侧桡动脉途径冠状动脉介入治疗的临床分析

目的通过对比左右桡动脉两种途径行冠状动脉介入治疗的临床疗效,探讨经左侧桡动脉途径行冠状动脉介入治疗的安全性和有效性。方法入选2007年8月至2010年10月行经桡动脉途径冠状动脉介入治疗的患者970例,随机分为左侧桡动脉组486例（左侧组）,右侧桡动脉组484例（右侧组）,主要观察指标包括：介入手术成功率、血管开通时间、术中及术后不良事件发生率等。结果左侧组手术成功率为94.8,右侧组手术成功率为93.4,两组间差异无统计学意义。两组穿刺成功率、血管开通时间、X线透视时间、对比剂用量、手术总时间差异无统计学意义。结论经左侧桡动脉途径行冠状动脉介入治疗术安全有效。     

经桡动脉途径行冠状动脉介入治疗的护理

冠状动脉介入诊疗技术是一种非外科手术微创诊治冠心病的方法.随着介入诊疗技术的广泛开展,经桡动脉行冠状动脉介入诊治的优越性更为突出,本文就经桡动脉穿刺的方法及行冠状动脉介入诊疗术前术后的护理作一综述.     

右冠状动脉起源异常2例报告

先天性冠状动脉异常包括的范围较广但临床少见。笔者报告2例右冠状动脉异常起源的2例患者，并加以讨论。     

高龄患者经远端桡动脉入路行冠状动脉介入诊疗的可行性及安全性

目的 探讨经远端桡动脉入路在高龄患者中行冠状动脉介入治疗的可行性及安全性。方法 回顾性分析2019年9月至2021年12月在江苏大学附属武进医院心内科行冠状动脉介入治疗的高龄患者212例,根据首选穿刺入路分为远端桡动脉组90例和常规桡动脉组122例,比较2组穿刺成功率、穿刺时间、术后压迫止血时间等。结果 远端桡动脉组既往PCI比例、收缩压及舒张压明显高于常规桡动脉组(P<0.05,P<0.01)。远端桡动脉组总体穿刺成功82例(91.1%),常规桡动脉组穿刺成功117例(95.9%),2组穿刺成功率比较,差异无统计学意义(P>0.05)。远端桡动脉组1针穿刺成功率明显低于常规桡动脉组(63.3%vs 92.6%,P<0.01),穿刺时间明显长于常规桡动脉组[62(60,90)s vs 60(60,60)s,P<0.01]。远端桡动脉组VAS评分和止血时间明显低于常规桡动脉组(P<0.01)。结论 在高龄患者中经远端桡动脉行冠状动脉介入治疗安全有效。     

冠状动脉起源异常及其狭窄病变的介入性治疗

目的：探讨国人冠状动脉起源异常的检出频度，总结对其冠状动脉病变行介入性治疗的体会。方法：回顾性研究总结２６８０例接受冠状动脉造影检查的患者；对５例起源异常冠状动脉合并的狭窄病变施行了经皮冠状动脉腔内成形术（ＰＴＣＡ）或冠状动脉内支架植入术（ＩＣＳ）。结果：冠状动脉造影２６８０例中检出冠状动脉起源异常３０例，占１．１２％，５例ＰＴＣＡ和ＩＣＳ手术全部成功，无重要并发症发生。结论：对起源异常冠状动脉合并狭窄病变施行ＰＴＣＡ和ＩＣＳ是安全可行的。     

A Different Kind of Christmas Tree: Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery (ARCAPA)

Anomalous right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital coronary anomaly that has an incidence of 0.002%. We report a case of a previously healthy female who presented to our hospital with pneumonia and was incidentally discovered to have ARCAPA. This was initially diagnosed on echocardiography by the unusual echocardiographic finding of multiple color flow Doppler signals around the right ventricular free wall and apex which were subsequently confirmed by angiography to be due to extensive collateral circulation between the left and right coronary arteries. This represents an unusual echocardiographic manifestation of this very rare condition.     

Coronary intervention in anomalous origin of the right coronary artery (ARCA) from the left sinus of valsalva (LSOV): A single center experience

Objective

To assess the technical challenges in percutaneous coronary intervention of Anomalous right coronary artery arising from the left sinus of valsalva.

Methods

Between year 2008 and 2012, a total of 17 patients underwent PCI for an angiographically significant lesion in the right coronary artery of an anomalous origin in the LSOV. Their procedure details such as usage of catheters, radiation time, amount of contrast used were assessed.

Results

A total of 17 patients with anomalous right coronary artery underwent PCI during the above mentioned period. 8 patients had type A origin, 3 had type B origin and the remaining 6 had type C origin. Type A origin RCA were successfully cannulated in 6 patients with Judkins left 5.0 and in 2 patients using Judkins left 4.0. Extra back up (EBU) 3.5 were doing well in 2 patients of Type B origin and the remaining one patient was successfully cannulated using Judkins left 4.0. In type C origin 4 patients had successful cannulation with Amplatz Left 1.0, 1 patient with Amplatz Left 2.0 and 1 patient with Judkins left 4.0. The mean fluoroscopic time was 20.7 min and amount of contrast used was 210 ml.

Conclusion

PCI of anomalous RCA origin from LSOV requires appropriate guide catheter selection according to the anatomy of origin for successful cannulation and to reduce the contrast usage and radiation exposure.     

Prognosis of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafts for Ostial Right Coronary Lesions in Propensity‐Matched Individuals

Objective: Our aim was to evaluate the relative safety and efficacy of percutaneous coronary intervention (PCI) with drug‐eluting stents (DES) versus coronary artery bypass grafts (CABG) for the treatment of ostial right coronary stenosis (ORCS) lesions. Methods: Three hundred fifty‐nine cases of ORCS lesion were treated via CABG (n = 232) or PCI (n = 127) procedures. Propensity scores for undergoing the CABG procedure were estimated and used to match 105 pairs of patients between the two groups. Kaplan–Meier major adverse cardiac and cerebrovascular events (MACCE)‐free curves were constructed to compare long‐term MACCE‐free survival between the two groups. Results: For the 105 propensity‐matched pairs, patients were more likely to undergo repeat revascularization with CABG in the PCI group than in the CABG group during the first 30 days (4 cases vs. 0 case, P= 0.043, χ²= 4.08) and the 1‐year follow‐up (5 cases vs. 0 case, P= 0.02, χ²= 5.17). With a mean follow‐up of 12.04 ± 6.47 months and a total of 210.67 patient–years, the freedom from MACCE in the CABG group was significantly higher than that in the PCI group (Log rank test, χ²= 4.48, P= 0.03). There were no significant differences in the rates of death, myocardial infarction, nonfatal stroke, death/myocardium infarction/stroke, or repeated PCI between the two groups during the first 30 days and during the 1‐year follow‐up period. Conclusion: For OCRS lesions, CABG provided greater protection than PCI procedure in terms of freedom from MACCE, mainly due to the reduced number of repeated revascularization procedures. CABG should be considered as first‐choice revascularization strategy for ORCS lesions.     

Anomalous Right Coronary Artery Origin in a High School Athlete

Coronary anomalies are the cause of 12% of sudden deaths among athletes. Similarly anomalous coronary origin from the opposite sinus is often found at autopsy. The use of echocardiography to screen for these types of defects may provide a potentially life‐saving diagnosis. The authors present a case that highlights the utility of echocardiography as part of a comprehensive screening program for athletes. (Echocardiography 2010;27:348‐350)     

成年人冠状动脉造影先天性变异分析

目的 :探讨成年人先天性冠状动脉变异 (畸形 )的检出频度。　　方法 :回顾性研究总结 4173例患者的冠状动脉造影资料 ,准确判定各种先天性冠状动脉变异。　　结果 :1冠状动脉造影 4173例中检出冠状动脉开口起源异常 5 0例 ,检出率为 1.2 % ,其中各种右冠状动脉起源异常 42例 ,占 84.0 % ,左冠状动脉起源异常 7例 ,占 14.0 % ,左、右冠状动脉开口起源均异常 1例 ,占 2 .0 % ;2检出各种类型冠状动脉分支起源异常 15例 ,检出率为 0 .4% ;3检出各种类型冠状动脉瘘 2 8例 ,检出率为 0 .7% ,其中 18例(6 4.3% )为冠状动脉—肺动脉瘘 ;4其它少见冠状动脉变异 2例。　　结论 :成年人先天性冠状动脉变异的临床症状和体征多不典型或缺如 ,通常在心导管检查中被偶然发现 ,冠状动脉造影是确诊各种类型冠状动脉变异最重要的检查方法。