探讨320排CT下左冠状动脉前降支狭窄程度与左心功能的相关性

目的 利用320排CT探讨左冠状动脉前降支的狭窄程度与左心功能改变的相关性。方法 选择左前降支单支病变的患者108例,其中轻度狭窄患者44例,中度狭窄患者36例,重度狭窄患者28例,分别记为A组、B组、C组;另外选择健康对照组患者33例,记为D组。所有患者行CT冠状动脉造影,分析冠状动脉狭窄程度,并计算左心室射血分数（left ventricular ejection fractions,LVEF）、左心室心肌质量（left ventricular myocardial mass,LVMM）、左心室舒张末期容积（left ventricular end diastolic volume,LVEDV）、左心室收缩末期容积（left ventricular end systolic volume,LVESV）、每搏排出量（stroke volume,SV）、心排出量（cardiac output,CO）。结果 对于左前降支病变的患者,随着左前降支狭窄程度的增加,LVEF逐步下降,并且对于中度狭窄以上的患者,LVEF显著低于正常对照组患者（P<0.05）。左前降支中度狭窄以上患者,LVEDV、LVESV及LVMM高于对照组患者（P<0.05）,并且LVMM随着左前降支狭窄程度的增加而升高。病变患者与对照组的SV及CO差异无统计学意义（P>0.05）。另外,左前降支病变患者中轻度狭窄的患者与对照组比较,除了LVMM外,其他心功能参数差异均无统计学意义（P>0.05）。结论 320排CT在评价冠状动脉粥样硬化狭窄与心功能的相关性具有重要价值。左冠状动脉前降支狭窄会引起左心功能降低,且会随着狭窄程度加重而下降,但左前降支轻度狭窄时左心功能下降并不明显。     

比索洛尔对冠心病心力衰竭患者心室重塑和心功能的影响

目的 :探讨比索洛尔对冠心病心力衰竭患者心室重塑及心功能的影响。方法 :冠心病心力衰竭患者 12 0例 ,左室射血分数≤ 45 % ,心功能 (NYHA)Ⅱ -Ⅳ级 ,常规治疗基础上随机分为比索洛尔治疗组和对照组。治疗 6个月 ,观察比索洛尔对心室重塑、心功能的影响。应用心脏彩色超声仪测定基线值及 1个月、3个月、6个月左室结构及功能指标变化。结果 :比索洛尔平均用量为 (7 5 0± 2 5 0 )mg/d ,经过 6个月治疗 ,比索洛尔治疗组症状和心功能改善 ,与对照组比较左室射血分数上升 [(4 9 2± 2 8) %VS(3 9 6± 3 6) % ,P <0 0 5 ] ,左室收缩末容积下降[(15 7 7± 42 6)mlVS(180 9± 3 9 6)ml] ;与基线比较左室舒张末容积下降 (P <0 0 5 )。结论 :在强心、利尿、血管紧张素转化酶抑制剂基础上 ,应用比索洛尔能显著改善冠心病心力衰竭患者的心功能 ,改善心室重塑。长期应用可改善衰竭心脏心肌细胞的生物学效应 ,这种有益的作用在不同心功能级别间无显著性差异     

Repair of left ventricular aneurysm during off-pump coronary artery bypass surgery

Background Acute myocardial infarction can result in left ventricular aneurysm, which may in turn cause congestive heart failure, ventricular arrhythmia and thromboembolic events. This study evaluates results achieved with a modified linear closure of left ventricular aneurysms during off-pump coronary artery bypass surgery. Methods From January 2001 to May 2004, 75 patients were operated on for nonruptured, postinfarctional, left ventricular aneurysm during off-pump coronary artery bypass surgery. Repair was completed on the beating heart to minimize ischaemia and allow assessment of wall function and viability to guide closure. All patients presented with symptoms of angina and congestive heart failure or ventricular arrhythmia. The majority (75%) of the patients were in NYHA functional class Ⅲ or Ⅳ. Preoperative ejection fraction was 26%±9%. The mean left ventricular, end diastolic diameter was (57.5±7.1) mm. The ventricular preoperative and postoperative performances were compared. χ2 test and Student’s t test were used to analyse the outcomes. A P value less than 0.05 was considered significant.Results Hospital mortality was 1.3% (1/75). Coronary artery bypass was performed with an average of (3.3±1.2) grafts per patient. At the time of followup, all the patients had no symptoms. The mean NYHA class and ejection fraction increased significantly (P&lt;0.001). The mean left ventricular, end diastolic diameter decreased significantly (P&lt;0.001). Conclusions Surgical closure of left ventricular aneurysm can be performed during off-pump coronary artery bypass. The operation is associated with a low inhospital mortality and morbidity. A postoperative improvement in the early term cardiac functions and symptoms and quality of life was documented, increasing our expectations of an increased long-term survival.     

老年冠心病患者冠状动脉病变对左心重构的影响

目的探讨老年冠心病患者冠状动脉病变对左心重构的影响。方法 2002年1月—2010年1月住院并完成冠脉造影的老年冠心病患者171例,其中有陈旧性心肌梗死病史患者76例,无陈旧性心肌梗死病史患者95例,按是否有左心室扩大分为左心室扩大组43例,无左心室扩大组128例,采集患者心脏超声数据及冠脉造影资料,计算冠状动脉Gensini积分,分析冠状动脉病变对左心重构的影响。结果 (1)无心肌梗死病史患者和有心肌梗死病史患者比较,LVEDD、LVESD、FS、AOD、LAD差异均有统计学意义(P<0.05,P<0.01),2组冠状动脉Gensini积分均与LVEDD、AOD、LAD均呈正相关性(P<0.01),与LVESD、FS均无相关性(P>0.05)。(2)左心室扩大组与无左心室扩大组比较,前降支病变、左冠状动脉病变、多支病变、弥漫病变及完全闭塞病变发生率差异均有统计学意义(P<0.01)。结论老年冠心病患者冠状动脉病变是左心室重构的重要原因。     

2型糖尿病患者左心室功能变化的临床研究

目的：探讨2型糖尿病（DM）对左心室功能的影响及其可能机制。方法：冠状动脉造影和左心室造影证实，有662例冠状动脉狭窄患者，分别按有无DM将其分为冠心病（CHD）合并DM（CHD＋DM）组及CHD组，测定各组左心室射血分数（LVEF）及左心室舒张末压（LVEDP），判断左心室收缩及舒张功能。结果：CHD＋DM组的LVEF值与CHD组无明显差异，根据LVEF〉50％、30％。的％和≤30％将心功能进一步分级后，CHD＋DM组与CHD组在不同心功能分级间亦无统计学差异。CHD＋DM组的LVEDP明显高于CHD组（P〈0．05）。结论：LVEDP是评估左心室舒张功能的敏感指标，CHD合并DM时比单纯CHD的心脏舒张功能受损更明显。产生机制与DM的胰岛素缺乏所致心肌能量代谢紊乱有关。此外，心肌细胞蛋白糖基化作用导致的氧化应激、细胞内Ca^2＋转运机制异常以及心脏局部肾素-血管紧张素系统（RAS）激活等均可损伤心肌的结构和功能。     

64排螺旋CT评估冠状动脉及左心室功能

目的：评估行64排螺旋CT冠状动脉成像（CCTA）的同时进行左心室功能分析定量评估的可行性和准确性。方法：对连续临床疑诊或确诊为冠心病的50例患者行64排螺旋CT回顾性心电门控CCTA检查。采用美国心脏协会冠状动脉分段法进行分段,采用4级评分法对每段冠状动脉成像质量进行评估。并以超声心动图检查结果为对照,对CT测得的左心室射血分数（LVEF）值进行统计学分析。结果：50例患者中,42例顺利完成了检查,其中35例同时进行了超声心动图左心室功能检查。共评价冠状动脉508段,其中可以用于诊断的占91．93％。64排CT与超声心动图所测得的LVEF值差异无统计学意义（t=-1．47,P=0．15）,两者有较高的相关性（r=0．64）。结论：64排螺旋CT可同时行冠状动脉成像及左心室功能分析,冠状动脉成像总体质量较好,左心室功能分析结果可靠。     

超声心动图观察冠心病对心脏结构和心功能的影响

本研究应用数字化 M 型超声心动图观察40例正常人和40例陈旧心肌梗塞患者的心脏结构和心功能,发现心肌梗塞组主动脉根部内径、左房及左室内经、左室后壁及室间隔厚度均明显大于正常组,左室短轴缩短率及射血分数明显低于正常组,等容收缩期、射血前期、等容舒张期、QC 及A_2E 间期延长,二尖瓣室间隔角加大.提示心肌梗塞患者不仅心脏结构发生明显变化,心脏收缩功能、泵功能及舒张功能亦均明显减退.     

The Continuity of Right and Left Ventricular Myocardial Sinusoidal Spaces and its Relation to Right Ventricular Implants

Evidence is presented which indicates that blood leaving side branches of an internal mammary artery implanted into the anterior wall of the right ventricle flows from the tunnel in which it lies through myocardial sinusoidal spaces of the anterior right ventricular wall across the midline to fill corresponding spaces in the anterior wall of the left ventricle and thence is carried to the left coronary sinus. The myocardial sinusoidal spaces of right and left ventricles have been well outlined, using injections of polyvinyl acetate and the technique of digestion casts. We have been able to show that there is no barrier between the myocardial sinusoids of the right circulation and those related to the anterior descending branch of the left coronary artery. In structure, these myocardial sinusoidal spaces are quite different from the intramyocardial coronary arteriolar zones which, in 93% of human hearts, are separated from one another without collateral communication.

The continuity of the right and left ventricular myocardial sinusoids explains why implantation of a right internal mammary artery into the anterior wall of the right ventricle combined with a corresponding left implant, epicardiectomy and free omental graft, has been so effective in our hands in the treatment of far-advanced human coronary artery insufficiency.

     

Beneficial effects of berberine on hemodynamics during acute ischemic left ventricular failure in dogs.

In 18 dogs ischemic left ventricular failure characterized by a 30 percent reduction in peak rate of rise of left ventricular pressure (+dp/dt) and elevation of left ventricular end-diastolic pressure (LVEDP) to 15 mmHg or more was produced by ligation of the proximal left anterior descending coronary artery followed by serial occlusions of the distal left circumflex coronary artery. In 10 days, administration of berberine in an intravenous bolus injection (1 mg/kg, within 3 minutes) followed by a constant infusion (0.2 mg/kg/min, 30 minutes) increased the cardiac output (CO) from 1.25 +/- 0.12 to 1.61 +/- 0.17 L/min (P < 0.05), and +dp/dt from 810 +/- 85 to 1021 +/- 130 mmHg/s (P < 0.01), and decreased LVEDP from 16.5 +/- 1.3 to 12.0 +/- 1.0 mmHg (P < 0.05), diastolic blood pressure from 94 +/- 6 to 84 +/- 5 mmHg (P < 0.01), systemic vascular resistance from 7303 +/- 278 to 5442 +/- 231 dynes.x/cm5 (P < 0.01), but did not affect the heart rate. Injection of 5% glucose with the same volume did not improve CO and dp/dt (P > 0.05) but increased the LVEDP from 17.1 +/- 1.4 to 17.8 +/- 1.6 mmHg (P < 0.01) in 8 dogs. The levels of plasma concentration of berberine was determined with high-performance liquid chromatography. The changes in plasma drug level were found parallel to hemodynamic effects of berberine. The results of this study showed that berberine was able to improve the impaired left ventricular function by its positive inotropic effect and mild systemic vasodilatation.

     

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。     

冠心病的Q-T离散度与冠脉狭窄程度及左室大小的关系

为探讨冠心病患者的Ｑ－Ｔ离散度与冠脉狭窄程度及左室大小的关系,观察了６５例冠状动脉单支狭窄〉６０％的冠心病患者,其中不伴左室增大者３７例,伴左室增大者２８例,正常对照组３５例。结果发现,伴有和不伴有左室增大的冠心病组的Ｑ－Ｔ离散度较正常组显著增大,Ｑ－Ｔ离散度与冠脉狭窄程度及左室大小呈正相关。提示Ｑ－Ｔ离散度可作为评价冠脉狭窄程度及左室肥大的参考指标之一。     

Ultrasonic evaluation of the relationship between left ventricular hypertrophy or left ventricular geometry and endothelial function in patients with essential hypertension

Objective

To assess the relationship between left ventricular hypertrophy (LVH) or left ventricular geometry (LVG) and endothelial function in patients with essential hypertension (EH).

Methods

Seventy-six patients and 30 normal subjects were first examined by echocardiography. Brachial artery dilatation induced by reactive hyperemia (DIRH) or nitroglycerin (DING) was detected using high-resolution ultrasonography.

Results

DIRH was lower in patients with hypertension than in the controls, and the decrease in DIRH was greater in the patients with LVH than that in patients without LVH (4.36±2.54% vs 8.56±1.87 %; P < 0.0001). There were no significant differences in age, serum concentrations of total cholesterol, triglycerides or sugar, blood pressure and the brachial artery dilatation induced by nitroglycerin between the two groups (P > 0.05). While there was no significant difference in DIRH between the patients with normal left ventricular geometry or cardiac remodeling, the patients showing either eccentric or concentric left ventricular hypertrophy had lower DIRH than the patients with normal left ventricular geometry or cardiac remodeling. The DIRH was the lowest in patients with concentric hypertrophy. Although bivariate analysis showed that the left ventricular mass index (LVMI) correlated well with the brachial artery dilatation induced by reactive hyperemia, diastolic blood pressure and mean blood pressure (r=-0.61, P < 0.0001; r = 0.27, P < 0.05; r = 0.31, P < 0.05, respectively), a multivariate stepwise regression demonstrated that LVMI correlated only with the brachial artery dilatation induced by reactive hyperemia.

Conclusion

Left ventricular hypertrophy was related to endothelial dysfunction in essential hypertension. The endothelial dysfunction might be basic and important in the progression of left ventricular hypertrophy.     

Total Arterial Revascularisation in Left Ventricular Dysfunction

Despite the excellent results achievable withcoronary artery bypass operations using a singlein-ternal mammary artery(I MA)graft to the left an-terior descending coronary artery(LAD)and addi-tional saphenous vein grafts,the long-term paten-cy of vein grafts in the coronary artery circulationhas beenless than that of arterial grafts.Choosingthe conduit with the highest early and long-termpatency for all of the diseased coronary arteries isone way to i mprove outcomes of coronary arterybypass …     

64层螺旋CT评估冠脉狭窄与左心室功能的临床应用研究

目的探讨64层螺旋CT用于评估冠状动脉狭窄与左室心功能相关性的临床应用价值。方法以77例冠状动脉狭窄患者作为研究对象,将其作为观察组,另选28例同期进行健康体检且无冠状动脉狭窄者作为对照组进行研究。所有受检者均接受64层螺旋CT和二维超声心动图左室功能检查,分别对采用两种方法所测得的两组患者的左室功能参数进行分析。结果 77例患者经64层螺旋CT与二维超声心动图检查所测得的EDV值、ESV值、SV值、EF值经Peasorn相关性检验表示具有良好的一致性,r=0.72-0.85。EDV值、ESV值、EF值、MM值与冠状动脉狭窄程度呈显著正相关(r=0.21、0.45、0.49、0.42,p0.05);SV值各组间差异均无统计学意义,与冠脉狭窄程度不具有相关性(r=0.07,P0.05)。结论64层螺旋CT同时评估冠状动脉狭窄与左室功能具有高度可行性,可准确评价冠脉狭窄对左室心功能造成的损害,狭窄程度越严重左心功能损害越大,可为临床治疗提供重要依据。     

Mediastinal diffuse large B-cell lymphoma invading the left atrium mimicking coronary artery disease with a mural thrombus

A left atrial mass associated with coronary artery disease is often diagnosed as a mural thrombus rather than other possible etiologies such as benign primary cardiac tumor (myxoma, lipoma), a malignant primary cardiac tumor (sarcoma, lymphoma), or secondary involvement for extracardiac tumors. Malignant lymphoma initially presenting as intracardiac masses is very rare. Chest computed tomography with contrast enhancement and cardiac magnetic resonance may be the best methods for distinguishing primary cardiac tumors from direct extension from adjacent mediastinal structures. We report the case of a 59-year-old man with incidentally found mediastinal diffuse large B-cell lymphoma invading the left atrium, which presented with coronary artery disease and a left atrial mass. Improvement in cardiac ventricular function heart after coronary artery bypass grafting may provide the patient with a better chance of receiving an adequate dose of chemotherapy.     

The Treatment of Multiple Coronary Occlusions by Internal Mammary Artery Implantation and Omental Graft: Report on Two Human Cases

The importance of triple coronary artery disease was evident in 125 patients undergoing internal mammary artery implantation, when some patients died from right coronary artery occlusion. This occurred even when the internal mammary artery was patent and revascularizing the left ventricle.

In 1961 the free omental graft operation was developed to revascularize both right and left ventricles. In animals this operation has proved most effective in preventing death after application of Ameroid constrictors to all three coronary arteries. Arteriolar or larger-sized vessels rapidly formed between the aorta and omentum and the pericardium and omentum and the heart and omentum.

Two patients with triple coronary artery disease underwent internal mammary artery implantation and free omental graft early in December 1962. Postoperative convalescence was uneventful. They have returned home and appear to be improved. Wrapping the entire heart with the free omental graft has produced little reaction, suggesting that, as in the animal, the grafts are surviving.

     

Myocardial perfusion imaging with thallium-201: correlation with coronary arteriography and electrocardiography

Myocardial perfusion imaging with thallium-201 and electrocardiography with the subject at rest and undergoing submaximal treadmill exercise were performed in 19 men and 3 women. Selective coronary arteriography and left ventriculography showed that 7 had normal coronary arteries and 15 had coronary artery disease.

The 11 persons with electrocardiographic evidence of an old myocardial infarct (q waves) had a perfusion defect at rest in the area of the infarct and a segmental abnormality of wall motion apparent on the left ventriculogram corresponding to the perfusion defect.

Myocardial perfusion imaging and electrocardiography were equally sensitive in detecting coronary artery disease in exercising individuals: perfusion defects were noted in 7 of the 15 persons with coronary artery disease, and diagnostic ST-segment depression was present in 8 of the 15. Combination of the results of the two tests with exercise permitted the identification of 11 of the 15 persons and improved the sensitivity. Combination of the results of rest and exercise imaging and electrocardiography permitted the identification of 94% of the patients with coronary artery disease.

Myocardial perfusion imaging with ²⁰¹TI in the subject at rest is a sensitive indicator of previous myocardial infarction. Imaging after the subject has exercised is a useful adjunct to conventional exercise electrocardiography, especially in those whose exercise electrocardiogram is non-interpretable.

     

卡维地洛对冠心病心力衰竭患者心室重构和心功能的影响

目的　探讨卡维地洛对冠心病心力衰竭患者心室重构及心功能的影响。方法　冠心病心力衰竭患者 80例 ,左室射血分数≤ 45 % ,心功能Ⅱ～Ⅲ级 ,常规治疗基础上随机分为治疗组和对照组 ,治疗 6个月 ,观察卡维地洛对心室重构、心功能的影响。结果　经过 6个月治疗 ,与对照组相比 ,卡维地洛组左室射血分数明显升高 (P <0 .0 1) ,左室收缩末容量指数、左室舒张末容量指数、左室重量指数均显著降低 (P <0 .0 1)。结论　在常规治疗的基础上 ,应用卡维地洛能显著改善冠心病心力衰竭患者的心功能 ,改善心室重构     

冠状动脉病变与左心功能的相关性研究

目的：探讨冠心病人冠状动脉病变与左心功能的关系。方法：对３４例心绞痛、３０例心梗及３６例正常对照行选择性冠状动脉造影（ＣＡＧ）和左心室造影,冠状动脉病变结合电影影像和数字减影影像进行专家目测和自动测量对照分析,左心功能研究采用室壁运动自动分析软件进行分析,冠心病按一支或多支血管有５０％以上狭窄确定诊断。结果：心绞痛组和心梗组患者,左心功能和冠状动脉病变支数及严重程度明显相关,多支血管病变患者 功能减损超过单支血管病变患者,且冠状动脉狭窄愈重,左心功能减损愈明显。结论：冠心病左心功能和冠状动脉病变严重程度密切相关。     

Congenital left ventricular diverticulum diagnosed by echocardiography

To the editor:Left ventricular diverticulum is a rare congenital anomaly,and poorly understood.The first patient was described by O'Bryan in 1838) Here we report a case of a 19-year-old young man with isolated huge left ventricular divertivulum He was admitted to our hospital for heart assessment.He had no connective tissue disorders or other systemic anomalies,and there was no signification family history of disease.Transthoracic echocardiography and magnetic resonance imaging (MRI) showed a large outpouching lesion that contained full-thickness myocardium at the anterolateral wall of the left ventricle without any other cardiac defects (Figure 1).Computed tomography angiography showed no significant coronary artery stenosis.This established the diagnosis of isolated left ventricular diverticulum.The man's cardiac function was within normal limits,and a surgical procedure was not indicated.