老年人先天性冠状动脉畸形及其临床意义

目的探讨老年冠脉造影人群先天性冠状动脉畸形(CCA)的发生率、类型及其临床意义。方法2000年10月~2005年12月共940例年龄≥60岁的老年患者在我院行冠脉造影,对其中检出有CCA患者的临床资料进行回顾性分析。结果940例患者共检出CCA27例(发生率2.87%),包括冠脉起源和分布异常18例(占66.7%),冠状动脉瘘9例(占33.3%)。按CCA可能导致的临床后果分类,良性畸形占70.4%(19/27),有潜在危险畸形占29.6%(8/27);对后者随访6个月~5年,未发现畸形动脉与患者心脏事件有明确关系。结论老年人CCA并非少见,通常在冠脉造影时被发现,但大多数CCA并不导致明显临床后果。     

冠状动脉起源异常多层螺旋CT诊断及临床意义

目的 总结冠状动脉先天性起源异常的多层CT表现和临床意义.方法 回顾性分析4 581例冠状动脉CT血管造影(CT angiography, CTA)检查的影像和临床资料,冠状动脉起源异常者41例,男性34例,女性7例,年龄3～81(54.3±15.6)岁.观察CTA横轴位薄层重建图像,再进行多平面重组(multi-planar reconstruction, MPR)、最大密度投影(maximum intensity project, MIP)和容积再现(volume rendering, VR)后处理观察.结果 冠状动脉起源异常41例,发生率为0.9%.41例中,右冠状动脉起源于左冠窦9例,高位开口6例;左冠状动脉高位开口4例,左冠状动脉起源于右冠窦3例;左前降支与左旋支分别起源于左冠窦8例,左前降支起源于右冠状动脉2例,左旋支起源于右冠状动脉5例;左右冠状动脉共干起源4例.41例中23例有发作性胸闷、心悸,4例有心绞痛,其中2例有心源性休克.结论 多层螺旋CTA可无创性显示冠状动脉起源及走行异常,应作为疑诊冠状动脉起源异常的首选影像学检查方法.     

右冠状动脉起源异常1例

1　病例报告患者女性 ,6 5岁 ,因发作性心前区疼痛 10余年 ,加重 1周入院。诊断为冠状动脉粥样硬化性心脏病 ,混合性心绞痛。入院后经应用肠溶阿斯匹林、消心痛、倍他乐克、硫氮卓酮等药物 ,心绞痛仍时有发作 ,为明确冠状动脉病变部位及程度 ,欲行经皮冠状动脉腔内成形加支架置入术 ,决定行选择性冠状动脉造影检查。病人仰卧位 ,常规碘酒消毒局部皮肤 ,1%利多卡因局麻成功后 ,置入 6Ｆ动脉鞘管 ,注入肝素30 0 0Ｕ ,用ＪＬ4 0导管行左冠脉造影 ,导管不能进入冠脉口 ,考虑冠脉开口变异 ,更换Ａｍｐｌａｔｚ导管造影 ,见左、右冠状动脉均起在…     

心肌桥的冠状动脉造影影像特征及临床意义

目的 分析心肌桥在冠状动脉造影中的表现并探讨其临床意义。方法 回顾性分析在接受选择性冠状动脉造影的618例病人中共检出的心肌桥13例，结果 心肌桥发生率为2.1%，均为单桥，其中12例发生在左冠状动脉前降支，1例在左冠状动脉旋支，临床诊断单纯性心肌桥7例，3例合并冠状动脉粥样硬化性心脏病，2例合并高血压，1例，合并肥厚性心肌病；所有病例均行内科药物治疗，2例置入支架，结论 心肌桥在冠状动脉造影中检出率较低，其造影表现应与冠状动脉粥样硬化和假性心肌桥相鉴别；临床上对有症状的心肌桥 患者应当积极治疗。     

双源CT冠状动脉成像检查异常冠状动脉起源的意义

目的冠状动脉起源、走行和终止异常是潜在的威胁生命的解剖变异。文中评价双源CT(dual-source computed tomography,DSCT)对检出成人非先天性心脏病患者冠状动脉起源异常的价值。方法回顾性分析2008年12月至2010年2月期间进行DSCT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。结果在2179例进行冠状动脉检查的患者中2177例为非先天性心脏病患者,共检出28例(1.3%)冠状动脉起源异常。其中17例为右冠状动脉起源异常(13例起自左冠状窦,4例为高位起源),10例为左冠状动脉起源异常(5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 DSCT可良好显示冠状动脉起源异常及走行,为临床决策提供重要信息。     

少见冠状动脉异常形态

我们将2002年11月-2005年3月间完成的146例冠状动脉造影(CAG)中发现的冠状动脉畸形(CAA)、动脉瘤样扩张与冠脉短小等异常血管影像,归为少见冠状动脉异常形态.本组共5例,男性4例、女性1例,平均年龄58.00±13.35岁.现将有关情况报告如下.     

先天性左冠状动脉缺如合并前间壁导联异常1例

<正>冠状动脉(冠脉)畸形是一种罕见的先天发育性畸形,不同的冠脉畸形对心脏供血的影响各异,其中单支冠脉畸形(SCA)是指单支起源于主动脉的冠脉为全心活动进行血液供应^[1-3]。左冠状动脉(左冠)缺如代表整个心脏由唯一右冠状动脉(右冠)供血,目前SCA以右冠缺如报告多见而左冠缺如罕见。南昌大学第二附属医院心血管内科2021年7月27日收治1例先天性左冠缺如患者,现将其诊疗资料报告如下。     

冠状动脉心肌桥的检测及其临床意义

目的 探讨提高冠状动脉造影中心肌桥检出率及临床意义。方法 在冠状动脉造影中采用多体位投照，对可疑者经冠状动脉内注射硝酸甘油200μg后复查造影，对检出有冠状动脉心肌桥患者的临床资料进行分析。结果 460例行冠状动脉造影的患者中检出心肌桥38例，检出率8．2％。其中37例为左前降支，1例为右冠状动脉后降支。38例中，肌桥近段冠状动脉管壁不规则提示有粥样硬化表现者21例(55．6％)。结论 冠状动脉造影可以提高冠状动脉心肌桥的检出率；心肌桥绝大部分位于左前降支，其近段冠状动脉易发生粥样硬化；心肌桥所致的冠状动脉狭窄，可致心肌缺血，引起心绞痛、心肌梗死甚至猝死。     

冠状动脉起源异常29例

目的：了解冠状动脉起源异常（coronary artery origin anomalies,CAOA)的情况。方法：回顾性分析我院从1995至2001年2416例冠状动脉造影结果。结果：CAOA29例（1．2％），其中左前降支（LAD）和回旋支（LCX）分别独立起源于左冠状窦17例（58．6％），右冠（RCA）起源于左冠状窦6例（20．7％），RCA起源于升主支脉1例（3．4％），LCX起源于右冠状窦4例（13．8％）LCX起源于RCA1例（3．4％）；29例患者中除5例（17．2％）合并有冠状动脉狭窄外，其余24例（82．8％）患者未见冠状动脉狭窄。结论：CAOA是影响冠状动脉造影响的因素之一，但细胞观察左心室造影结果，选用不同型号的造影导管，终能满意地显示冠状动脉。最常见的类型是LAD和LCX分别独立起源于左冠状窦，大多数异常类型并不导致严重的临床症状，只有少数需要外科手术治疗。     

右冠脉起源异常经桡动脉介入治疗的疗效观察

目的观察国人右冠状动脉异常起源于左冠状动脉窦并对其经桡动脉行冠状动脉介入性治疗（PCI）的效果。方法回顾性分析2200例接受冠脉介入治疗的患者,总结其中19例右冠状动脉异常起源于左冠状动脉窦并经桡动脉行PCI患者的治疗经验。结果 19例患者异常起源右冠状动脉共植入22枚支架,植入成功率100%,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PCI是安全可行的,可在临床推广应用。     

冠心病患者脂蛋白α的分布特征及临床意义

目的探讨不同性别和年龄冠心病患者体内脂蛋白α水平的分布特征及其与冠状动脉血管病变程度的关系。方法选择行冠状动脉造影确诊的冠心病住院患者572例,将所有冠心病患者根据年龄分为中老年组155例和老年组417例。收集患者临床资料、生化指标及冠状动脉造影结果。采用简单线性相关分析冠心病的影响因素。结果①男性冠心病患者与女性冠心病患者比较,女性脂蛋白水平显著高于男性(P<0.05)。②单支、双支和三支病变组脂蛋白α水平三组间比较差异均有统计学意义(均P<0.05)。③简单线性相关分析显示Gensini积分仅与脂蛋白α相关,脂蛋白α与TC、LDL-C、APO B和Gensini积分相关。结论脂蛋白α是冠心病的独立危险因素。     

老年冠心病患者冠状动脉与肠系膜上动脉相关性研究

目的 提高对老年冠心病患者并发肠缺血的认识,完善冠心病防治规则.方法 选择经临床和影像检查确诊的36例老年(65～74岁)冠心病患者与31例中青年(35～50岁)冠心病患者的肠系膜上动脉造影影像进行对比分析,分析年龄与肠系膜上动脉之间以及冠状动脉病变程度与肠系膜上动脉病变之间的关系.结果 观察组36例中19例(52.8%)肠系膜上动脉病变,对照组31例中3例(9.7%)肠系膜上动脉病变(P＜0.05).观察组冠状动脉多支血管病变者24例(66.7%),对照组多支血管病变者7例(22.6%)(P＜0.05).冠状动脉多支血管病变者31例(46.2%),合并肠系膜上动脉病变19例(19/22,86.3%);单支血管病变36例(53.7%),合并肠系膜上动脉病变3例(3/22,13.6%)(P＜0.05).结论 冠心病患者的年龄与肠系膜上动脉病变之间有紧密相关性,年龄越大,冠状动脉损害越严重,肠系膜上动脉损害多在冠状动脉损害较严重时发生,应重视老年冠心病患者并发肠缺血的存在.     

Clinical features and long-term prognosis of patients with anomalous origin of the left coronary artery from the pulmonary artery

Background Anomalous origin of the left coronary artery from the pulmonary artery （ALCAPA） is a rare congenital heart anomaly. We aimed to illustrate the clinical features and long-term prognosis of patients with ALCAPA.Methods Twenty three patients （13 males and 10 females, ages ranging from 2.5 months to 65 years） identified as ALCAPA in Beijing Anzhen Hospital from April 1984 to June 2009 were divided into two groups, based on the age of onset： group 1 （≤12 months, n=16） and group 2 （〉12 months, n=7）.Results Fifty six point three percent of patients in group 1 had been misdiagnosed as endocardial fibroelastosis （9/16）,18.8% as dilated cardiomyopathy （3/16） and 6.3% as myocardial infarction （1/16）. Patients in group 2 were usually diagnosed as coronary heart disease, myocarditis, or patent ductus arteriosus. Electrocardiography in group 1 revealed abnormal Q waves with T wave inversion in leads I, avL, V4-V6, especially in lead avL （deep and wide Q wave）; but no specific manifestations in group 2. A higher percentage of patients in group 1 had cardiomegaly on chest radiograph （86.7% vs. 33.3%, P=0.031）, while pulmonary artery protrusion was more common in group 2 （26.7% vs. 83.3%,P=0.046）. Lower left ventricular ejection fraction （LVEF） was present in group 1 than in group 2 （（48.5±11.5）% vs.（65.0±6.1）%, P 〈0.001）. Apical ventricular aneurysm （62.5% vs. 0%, P=0.007）, enhanced echogenicity of papillary muscles （87.5% vs. 28.6%, P=0.011） and endocardial thickening （93.8% vs. 14.3%, P 〈0.001） were more frequent in group 1 than in group 2. The ratio of the proximal right coronary artery （RCA） diameter to the aortic root diameter exceeded 0.14 in all cases, more prominent in group 2 （0.26±0.05 vs. 0.33±0.03, P=0.009）. Increased coronary artery collaterals within the interventricular septum were detected in 18 patients （78.3%） by Doppler imaging. Twenty one patients underwent cardiac surgery, including left coronary artery （LCA） ligation （1/21）, LCA ligation plus coronary artery bypass grafting （1/21）, Takeuchi operation （7/21）, and LCA reimplantation surgery （12/21）. Four patients underwent concomitant mitral valve repair and one received mitral valve replacement. Aneurysm resection was performed in 3 cases. Six patients died in hospital after surgery, and the rest of the cohort had no overt symptoms during a follow-up period of 6 to 166 months. Their abnormal Q waves gradually regressed or disappeared, and the LVEF and left ventricle size returned to normal range with alleviation of mitral insufficiency.Conclusions The accurate diagnosis of ALCAPA can be made with serial diagnostic methods. ALCAPA can be successfully treated with several types of cardiac surgery, and surgeries of establishing two-coronary-artery circulation are the preferred operations nowadays, with good long-term prognosis.     

老年冠心病合并糖尿病患者冠状动脉病变特点分析

目的:探讨老年冠心病合并糖尿病患者冠状动脉病变特点.方法:冠状动脉造影确诊为冠心病的老年(≥60岁)住院患者134例,其中合并2型糖尿病42例,未合并糖尿病92例,比较2组冠脉病变的特点及相关临床因素.结果:2组体质指数(BMI)、吸烟年限、高血压病史、血脂差异均无统计学意义(P＞0.05);2组冠脉病变狭窄程度及受累血管数及部位差异无统计学意义(P＞0.05),但合并糖尿病组病变数、末梢病变数较高(P＜0.05).多元逐步回归分析结果显示,老年患者冠脉病变狭窄程度的影响因素有低密度脂蛋白、年龄和吸烟年限;冠脉病变数、末梢病变数与糖尿病呈正相关.结论:老年冠心病合并糖尿病患者冠脉病变数多、末梢病变多.血脂代谢异常、吸烟合并糖尿病的老年患者更易发生冠脉病变.     

Two congenital coronary abnormalities affecting heart function: anomalous origin of the left coronary artery from the pulmonary artery and congenital left main coronary artery atresia

Background The anomalous origin of the left coronary artery （LCA） from the pulmonary artery （ALCAPA） and congenital left main coronary artery atresia （CLMCA-A） are two kinds of very rare coronary heart diseases which affect heart function profoundly.This study aimed to retrospectively illustrate the clinical features and therapy experience of ALCAPA and CLMCA-A patients.Methods From April 1984 to July 2012,in Beijing Anzhen Hospital,23 patients were diagnosed with ALCAPA and 4 patients with CLMCA-A.We summarized the clinical data of the 27 cases and retrospectively analyzed the clinical manifestation,diagnosis,and treatments of these two kinds of congenital coronary abnormalities.Results The 23 patients （13 males and 10 females,aged ranging from 2.5 months to 65 years） identified with ALCAPA were classified into infantile type （age of onset younger than 12 months,16 cases） and adult type （age of onset older than 12 months,7 cases）.Four patients were diagnosed with CLMCA-A （three males and one female,aged ranging from 3 months to 2 years）.The main clinical manifestations of infantile-type ALCAPA and CLMCA-A include repeated respiratory tract infection,heart failure,dyspnea,feeding intolerance,diaphoresis,and failure to thrive.And these two congenital coronary abnormalities might be misdiagnosed as endocardial fibroelastosis,dilated cardiomyopathy,and acute myocardial infarction.As for the adult-type ALCAPA,cardiac murmurs and discomfort of the precordial area are the most common presentations and might be misdiagnosed as coronary heart disease,myocarditis,or patent ductus arteriosus.In ECG examination：Infantile-type ALCAPA and CLMCA-A showed abnormal Q waves with T wave inversion in leads I,avL,and V4-V6,especially in lead avL.However,ECG of adult-type ALCAPA lacked distinct features.In chest radiography：pulmonary congestion and cardiomegaly were the most common findings in infantile-type ALCAPA and CLMCA-A,while pulmonary artery segment dilation was more common in adult type.In ech     

Stenting for left main stenosis in a child with anomalous origin of left coronary artery: case report

Anomalous left coronary artery (LCA) arising from right cusp is an uncommon condition. Clinical evidence has shown that this coronary anomaly is consistently related to sudden death. Current treatment options include modification ofbehaviour, medicine or surgery. Stents have been successfully applied for left main stenosis for a decade.     

Stenting for left main stenosis in a child with anomalous origin of left coronary artery: case report

Anomalous left coronary artery (LCA) arising from right cusp is an uncommon condition. Clinical evidence has shown that this coronary anomaly is consistently related to sudden death. Current treatment options include modification of behaviour, medicine or surgery. Stents have been successfully applied for left main stenosis for a decade. We report a case of LCA arising from right cusp with left main stenosis treated with coronary stent in a child patient.     

儿童左冠状动脉异常起源于肺动脉的手术治疗效果及随访

目的：总结左冠状动脉异常起源于肺动脉（ ALCAPA）的手术效果和随访结果。方法回顾性分析20例ALCAPA患儿的临床资料。术前左室射血分数（ EF）8％～65％,其中16例EF＜40％。20例患儿均在中低温体外循环下,移植左冠状动脉至升主动脉,其中8例行急诊手术,其余12例为亚急诊手术。6例同期行二尖瓣成形术。结果住院死亡3例（15％）,1例为术后低心排血量综合征,2例死于术后顽固性室颤。失访1例,另16例存活患儿无院外死亡,随访3～67个月。术前EF＜40％的患儿中有61．5％（8／13）在术后3～6个月期间EF升至50％以上;术前EF＜40％、随访1年以上的患儿中有90．9％（10／11） EF升至50％以上。结论外科手术移植左冠状动脉至升主动脉是治疗ALCAPA的有效方法。术后低心排血量综合征和恶性心律失常是其主要死亡原因。患儿如能安全度过围术期,心功能有望恢复正常,远期预后良好。