The behavior of collateral circulation after coronary artery bypass surgery

The changes in coronary collateral circulation after bypass surgery were analyzed in 50 patients with coronary disease. The demonstration of collateral circulation was found to be dependent upon the severity of the coronary heart disease and the patency of the bypass. When the graft was patent, it was usually not possible to visualize the collateral circulation demonstrated preoperatively. When the bypass was occluded, the same collateral circulation as before surgery was frequenctly found.     

Three-dimensional teaching model for coronary angiography

In order to improve the understanding and interpretation of cine coronary arteriograms obtained in various angled projections, a three-dimensional wire model was constructed. The main coronary arteries and most important muscular branches are simulated by a wire skeleton. The model can be rotated to simulate the standard right and left anterior oblique and left lateral projections. The degree of rotation is indicated on the base of the model. By tilting the model, cephalad and caudad tube angulation can be simulated. By placing the model in front of the cine projector, the shadows of the wires can be superimposed upon the projected cine coronary arteriogram. This simple, inexpensive model has greatly improved the three-dimensional understanding of the coronary arterial tree in various angled and nonangled views and in our practice had led to the development of additional useful projections.     

Coronary artery calcium screening: current status and recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging

Current guidelines and literature on screening for coronary artery calcium for cardiac risk assessment are reviewed for both general and special populations. It is shown that for both general and special populations a zero score excludes most clinically relevant coronary artery disease. The importance of standardization of coronary artery calcium measurements by multidetector CT is discussed. This consensus article is being published concurrently in the Springer Journal International Journal of Cardiovascular Imaging.     

Coronary venous anatomy and anomalies

Coronary venous anatomy can be divided into the greater cardiac venous system and the lesser cardiac venous system. With protocol optimization, including appropriate contrast bolus timing, coronary veins can be depicted with excellent detail on CT. Knowledge of variant coronary venous anatomy can sometimes play a role in pre-procedural planning. Analysis of the coronary venous anatomy on CT can detect coronary venous anomalies that cause right to left shunts with risk of stroke, left to right shunts, and arrhythmias.     

冠状动脉夹层(附14例报告)

目的：探讨冠状动脉夹层的造影表现、分型与临床预后的关系。材料和方法：１４例中男１３例、女１例。临床诊断冠心病，其中９例有心肌梗塞史。冠状动脉造影均显示内膜撕裂瓣片形成的线样透亮线；其中１２例为ＰＴＣＡ术后。结果：轻度内膜撕裂３例、平行夹层分离４例、局限型夹层分离５例、螺旋型分离２例。１４例中９例假腔内造影剂排空正常或轻度排空延迟，真腔无明显受压，病人无重要临床并发症。５例假腔造影剂排空延迟，真腔中－重度受压，其中３人出现急性心肌缺血和心肌梗塞体征。结论：结合临床预后冠状动脉夹层可分为真腔受压和真腔无明显受压两大类，后者一般不产生严重临床症状和体征；而前者可产生严重临床并发症，需要紧急治疗。     

Unusual origin and course of the first septal branch of the left coronary artery: Angiographic recognition

The anatomical variants of the origin and course of the first septal branch (S1) of the left coronary artery system have received little attention in the literature dealing with coronary angiography. We describe here the angiographic features of the ectopic origin of S1 from epicardial branches of the left coronary artery other than the left anterior descending artery as observed in 8 cases from a series of 700 consecutive patients (1.1%). The S1 originated from the left main coronary artery in 1 case, from a diagonal branch in 4, and from an intermediate branch in 3 cases. Previous reported cases are reviewed. Because the S1 may supply up to 15% of the blood to the myocardium, the recognition of this variable origin may have clinical implications and has to be considered as a part of the complete evaluation of coronary arteriograms of patients referred for coronary artery revascularization.     

334例选择性冠状动脉造影分析

目的:探讨冠心病病人冠状动脉病变范围、程度、评估冠脉造影价值及其局限性。方法:用Judkins法行选择性左、右冠脉造影334例,观察并记录冠脉病变范围和程度。结果:334例冠脉造影有病理性改变212例(63.4%),其中单支病变97例(45.7%),双支病变66例(31.1%)三支病变45例(21.2%),四支病变4例(1.9%)。共累及417支血管,分别为前降支207支(49.6%),右冠119支(28.5%),回旋支85支(20.3%)左主干6支(1.4%)。心肌梗塞组(A组)阳性率88.9%,心绞痛组(B组)80%,胸痛组(C组)11.7%。结论:选择性冠状动脉造影仍然是诊断冠心病的金标准,它具有其他无创性检查无法替代的作用。     

电子束CT检测冠状动脉钙化的方法及初步结果报告

目的：报告电子束ＣＴ检测冠状动脉钙化（ＣＡＣ）的方法和初步研究结果。材料和方法：将经ＩｍａｔｒｏｎＣ－１５０电子束ＣＴ机检查冠状动脉的９０例分为三组：（１）非冠心组；（２）可疑组；（３）冠心组。对各例冠状动脉的走行进行观察；对比分析各组ＣＡＣ的发生率和钙化定量积分。结果：电子束ＣＴ能清晰地显示冠状动脉主干及主要分支。ＣＡＣ发生率冠心组为９５．０％（１９／２０例），可疑组为４８．６％（１７／３５例），非冠心组为２２．９％（８／３５例），差别具有显著性（ｐ＜０．００１）。发生ＣＡＣ的４４例中，冠心组的定量总分显著高于可疑组和非冠心组（Ｐ值分别＜０．０５和＜０．０１）。结论：电子束ＣＴ检测ＣＡＣ可为早期冠心病的诊断、预测和防治提供依据。     

冠状动脉造影表现与临床特征对照分析（附220例报告）

目的：对220例CAG影像表现与临床特征进行对照分析探讨两者之间的关系。方法：回顾性分析220例CAG的影像表现及临床特征。结果：CAG显示冠状动脉正常115例、狭窄105例,（男89例,女16例）,其中单支狭窄45例（42．9％）、2－3（左主干）支60例（57．1％）,轻度狭窄4例（3．8％）、中度狭窄14例（13．3％）、重度狭窄87例（82．9％）。结论：通过CAG可以明确诊断冠心病及全面了解冠状动脉狭窄的程度,也提示了冠心病患者一旦出现临床症状,冠状动脉狭窄一般较为严重。     

The Diagnostic Accuracy, Image Quality and Radiation Dose of 64-Slice Dual-Source CT in Daily Practice: a Single Institution's Experience

Objective

We wanted to evaluate the image quality, diagnostic accuracy and radiation exposure of 64-slice dual-source CT (DSCT) coronary angiography according to the heart rate in symptomatic patients during daily clinical practice.

Materials and Methods

We performed a retrospective search for the DSCT coronary angiography reports of 729 consecutive symptomatic patients. For the 131 patients who underwent invasive coronary angiography, the image quality, the diagnostic performance (sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV] for detecting significant stenosis ≥ 50% diameter) and the radiation exposure were evaluated. These values were compared between the groups with differing heart rates (HR): mean HR < 65 or ≥ 65 and HR variability (HRV) < 15 or ≥ 15.

Results

Among the 729 patients, the CT reports showed no stenosis or insignificant coronary artery stenosis in 72%, significant stenosis in 26% and non-diagnostic in 2%. For the 131 patients who underwent invasive coronary angiography, 95% of the patients and 97% of the segments were evaluable, and the overall per-patient/per-segment sensitivity, the perpatient/per-segment specificity, the per-patient/per-segment PPV and the per-patient/per-segment NPV were 100%/90%, 71%/98%, 95%/88% and 100%/97%, respectively. The image quality was better in the HR < 65 group than in the HR ≥ 65 group (p = 0.001), but there was no difference in diagnostic performance between the two groups. The mean effective radiation doses were lower in the HR < 65 or HRV < 15 group (p < 0.0001): 5.5 versus 6.7 mSv for the mean HR groups and 5.3 versus 9.3 mSv for the HRV groups.

Conclusion

Dual-source CT coronary angiography is a highly accurate modality in the clinical setting. Better image quality and a significant radiation reduction are being rendered in the lower HR group.     

Multiple coronary artery-left ventricular fistulas: A pattern of anomalous coronary microvascularization

Fistulas between the coronary artery and the left heart chambers are exceptionally rare, especially those emptying into the left ventricle. We know of 33 cases of coronary artery-left ventricular fistulas reported in the literature, 7 of which had multiple communications. The findings in 6 additional patients with multiple coronary artery-left ventricular fistulas are reported. Three of the 6 patients had fistulas communicating to the left ventricle from all three major coronary arteries. It is important to recognize this anomaly as it may be the source of angina in patients without angiographic evidence of major atherosclerotic coronary artery disease.     

拟诊冠心病患者心电图与冠状动脉造影结果分析

 目的通过对178例拟诊冠心病患者的静息心电图(ECG)与冠状动脉造影结果进行回顾性分析,评价静息心电图(ECG)对冠心病诊断和预后的价值.方法选择有冠心病典型症状及危险因素的患者,男109例、女69例,年龄62.5(61.5±11.1)岁.其中,99例患者ECG有心肌缺血表现(ECG阳性组),79例无心肌缺血表现(ECG阴性组).对所有拟诊患者进行冠状动脉造影(CAG)检查.结果静息ECG阳性与阴性组患者,CAG阳性率无显著性差异(54.5%vs 59.5%,P＞0.05);静息ECG对冠心病诊断的敏感性为56.4%,特异性为36.8%;静息ECG阳性组多支病变率明显高于ECG阴性组(66.7%vs 44.7%,P=0.029);静息ECG阴性组单支病变率明显高于ECG阳性组(55.3%vs 33.3%,P=0.026).静息ECG阳性组高血压患病率明显高于ECG阴性组(P=0.042).结论静息ECG阳性对诊断冠心病的特异性和敏感性低,对多支、多危险因素的高危冠心病患者具有一定的提示意义.     

心肌灌注显像联合冠状动脉钙化积分诊断冠心病的价值及最新进展

心肌灌注显像（MPI）在冠心病的诊断、危险度分层及预后评价中扮演着越来越重要的角色，冠状动脉钙化积分（CACS）可协助对冠心病患者进行进一步的危险度分层，但两者有各自的局限性和不足。将两者联合应用可以相互弥补不足，为临床提供更多的信息。行SPECT/CT心肌灌注显像时，需进行衰减矫正CT（CTAC）扫描，若采用心电门控的呼气末屏气螺旋CT扫描，则在用于MPI衰减矫正的同时又可用于CACS测定，实现一站式检查，在减少患者辐射剂量的同时又可为临床提供更多的信息。笔者综述了CACS、MPI及两者联合应用的临床价值，并对一站式采集MPI与CACS的最新进展进行了综述。     

Percutaneous transluminal coronary angioplasty in dextrocardia: Case report

Percutaneous transluminal coronary angioplasty (PTCA) is described in a patient with dextrocardia. Selective cannulation of the right anterior descending coronary artery (morphologic left anterior descending coronary artery) was achieved with modification of standard guiding catheters “preformed” for the normal, levo-position heart. This report demonstrates the feasibility of PTCA in patients with cardiac malposition who survive into adulthood and develop coronary atherosclerosis.     

Postmortem angiographic and pathologic-anatomic findings in coronary heart disease: A comparative study using planimetry

Comparisons of the results of angiographic and pathologic-anatomic estimations of the degree of coronary artery stenosis are rare and the findings contradictory. In the present study, postmortem examinations were carried out on 26 hearts with coronary artery disease. Quantitative planimetric measurements of 203 coronary artery cross-sections were performed and compared with the results of postmortem coronary angiograms. Using a score rating scale, a highly significant difference (P<0.001) between the angiographic and morphologic findings was detected, with the degree of stenosis underestimated angiographically in 96 of the 203 sections (47%), overestimated in 18 (9%), and correctly estimated in 89 (44%). The tendency to underestimation was equal in all of the coronary arteries (left anterior descending, circumflex, and right coronary arteries); there were no statistically significant differences (P<0.20,P<0.30,P<0.10). The frequency of angiographic underestimation of the degree of morphologic stenosis—especially in critical stenoses of more than 60%—has important implications in the assessment of whether coronary artery surgery is warranted. Dedicated to Prof. Dr. Walter Sandritter on the occasion of his 60th birthday     

多层螺旋CT冠状动脉钙化积分的研究进展

冠状动脉钙化积分对于冠心病的预测有重要的临床价值,随着CT技术发展,多层螺旋CT在冠状动脉钙化检测方面的价值逐渐成为临床研究的热点。本文叙述了多层螺旋CT在冠状动脉钙化积分方面的研究进展。     

冠状动脉畸形的16层CT诊断

冠状动脉畸形种类多,临床表现不一,其中较常见的是冠状动脉起源及分布异常,其他还有心肌桥、冠状动脉瘘和冠状动脉瘤等,既往确诊须凭借冠状动脉造影,多层螺旋CT可以无创详细显示畸形血管的部位、走行及其与周围结构的关系.本文从文献与我院病例相结合角度重点介绍冠状动脉畸形在16层螺旋CT上的表现,并认为多层CT可作为冠状动脉畸形的首选诊断方法.