电子束计算机断层血管造影及三维重建在冠状动脉搭桥术后的临床 …

目的 探讨电子束计算机断层（ＥＢＣＴ）血管造影及三维重建在冠状动脉搭桥术后的临床应用价值。方法 均采用单层增强扫描（ＳＳＭ）和血流扫描（ＦＬＯＷ ＳＴＵＤＹ）;三维重建采用表面阴影显示法（ＳＳＤ）,并与手术结果做了对照,其中７例有术后造影检查结果。结果 １５０例ＥＢＣＴ扫描及三维重建均获得成功;３９９支搭桥血清血管中有３１８支显示通畅,通畅率为７９．７％;其中,１００支乳内动脉桥中８７支通畅（占８     

电子束计算机断层血管造影及三维重建在冠状动脉搭桥术后的临床应用

目的探讨电子束计算机断层（ＥＢＣＴ）血管造影及三维重建在冠状动脉搭桥术后的临床应用价值。方法均采用单层增强扫描（ＳＳＭ）和血流扫描（ＦＬＯＷＳＴＵＤＹ）；三维重建采用表面阴影显示法（ＳＳＤ），并与手术结果做了对照，其中７例有术后造影检查结果。结果１５０例ＥＢＣＴ扫描及三维重建均获得成功；３９９支搭桥血管中有３１８支显示通畅，通畅率为７９７％；其中，１００支乳内动脉桥中８７支通畅（占８７％），２９６支大隐静脉桥中２２８支通畅（占７７％），３支桡动脉桥全部通畅（１００％）。７例患者ＥＢＣＴ结果显示１２支桥有５支发生了阻塞，与其造影结果一致。结论ＥＢＣＴ是评价搭桥血管通畅与否的很有价值的无创方法，并有望取代常规心血管造影。     

双源CT在冠状动脉旁路移植术后随访中的应用

目的 探讨双源CT在冠状动脉搭桥术后的临床应用及其价值.方法 对2009年1月～2010年8月期间27例冠状动脉搭桥术（CABG）后患者的CTA影像资料进行分析,对桥血冠状动脉管狭窄进行诊断.其中有10例患者同期行选择性冠状动脉造影术.结果 所有患者顺利完成冠状动脉图像采集,所有桥血管均显影,并且都可进行评价,其中共15条桥血管出现狭窄.和CAG结果相比,双源CT对狭窄判断的敏感性100%、特异性91.3%、准确率93.1%,出现狭窄的血管与血管类型有关,2年内通畅率动脉桥高于静脉桥.结论 双源CT可以准确评价冠状动脉桥血管通畅情况,是术后评价冠状动脉桥血管病变的首选检查方法.     

Midterm Follow-up of Coronary Artery Bypass Grafting with 64-Slice Multi-detector Computed Tomography:Identification of Risk Factors Affecting Graft Patency

Objective To identify the risk factors that are associated with the midterm coronary artery bypass grafting (CABG) functionality by assessing patency of left internal mammary artery (LIMA) graft and saphenous vein (SV) graft with 64-slice multi-detector computed tomography (64-MDCT). Methods Patients who underwent CABG operation and postoperative 64-MDCT follow-up examinations from August 2012 to December 2015 were included. The graft patent status was classified into patent and poor patent according to MDCT findings predominantly on 3D reconstructed images by two radiologists. The clinical data and imaging findings of the patients were collected and compared between the patent group and poor patent group. Univariate analysis and the multivariate logistic regression analysis were performed to identify the risk factors that affect graft patency. Results Among 341 patients in the study, there were 330 LIMA grafts [326 anastomosed to the left anterior descending artery (LAD), 4 to right coronary artery (RCA)] and 564 SV grafts (SVG) [100 anastomosed to the diagonal branch (D), 226 to the obtuse marginal branch (OM), and 238 to the RCA territory]. The approximal vessel stenosis exceeding 90% occurred in 268 of 292 patent LIMA grafts, and in 1 of 34 poor patent grafts (χ2=167, P<0.001). The patency rate was higher when SVG was anastomosed to OM (85.4%) or RCA territory (81.9%) than to D (69.0%) ( χ2=15.471, P=0.004). The proximal target vessel stenosis<90% ( OR=0.015, 95% CI: 0.01-0.14, P=0.000) was independently associated with the closure risk of LIMA grafts, the dyslipidemia (OR=1.52, 95% CI: 1.0-2.5, P=0.048), history of diabetes (OR=1.28, 95% CI : 0.90-2.26, P=0.045) and typical angina symptoms (OR=1.81, 95% CI :1.33-4.15, P=0.003) were independently associated with the closure risk of SVG. Conclusions The proximal LAD stenosis less than 90% was adversely associated with graft patency in LIMA recipients; dyslipidemia, diabetes and angina symptoms were associated with the midterm failure in SVG recipients. The choice of the target anastomosis sites may affect the patency of SVG.     

冠脉搭桥术：8例经验体会

目的　总结冠脉搭桥术（ Ｃ Ａ Ｂ Ｇ） 的临床经验和体会、寻找最佳的围术期处理方法。方法　分析８ 例 Ｃ Ａ Ｂ Ｇ 患者完整的临床资料。心绞痛７ 例,陈旧性心肌梗塞伴左室室壁瘤形成及发作性心绞痛１ 例。并发高血压病者６ 例,糖尿病３ 例。 Ｎ Ｙ Ｈ Ａ 心功能Ⅱ级１ 例,Ⅲ级４ 例,Ⅳ级３ 例。内乳动脉替代７ 例,共用大隐静脉桥１５ 支。结果　１ 例,术后因对角支静脉桥出血,行第２ 次开胸修补止血。次２ 日又因胸骨裂开,第３ 次开胸行胸骨再固定术。全组无手术死亡病例,出院时心绞痛症状完全缓解。结论　 Ｃ Ａ Ｂ Ｇ 成功的关键除病变部位的准确诊断外,桥的获取及良好的心肌保护至关重要。     

Evaluation of coronary artery bypass graft patency using three-dimensional re construction and flow study of electron beam tomography

目的　建立并评价电子束CT (EBT)两种方法在冠状动脉搭桥术后 (CABG)随访应用中的价值。方法　本组共 2 14例CABG患者进行了EBT两种方法的扫描 :(1)电子束CT血管造影 (EBA) ,以完成冠状动脉及搭桥血管的三维重建 ;(2 )电子束CT血流扫描 ,以得到冠状动脉及其搭桥血管的血流曲线。结果　本组共分析了 589条冠状动脉搭桥血管 (10条血管因图像伪影而除外 )。 133条动脉材料的血管桥通畅率超过静脉桥 (P <0 0 0 1)。三维重建方法诊断的敏感性、特异性和准确性分别是 97 7%、94 1%和 96 7% ,均高于血流扫描方法 (分别是 88 4 %、82 4 %和 85 2 % )。动脉与静脉血管桥内的平均血流量分别为 4 9± 2 2ml·min 1·g 1和 6 9± 2 8ml·min 1·g 1(P <0 0 0 1)。结论　电子束CT血管造影配合三维重建方法有利于观察冠状动脉及其搭桥血管的解剖 ,而血流扫描方法有利于观察并定量评估搭桥血管内的血流 ,两种方法的结合是理想的冠状动脉搭桥术后随访的无创影像方法     

MR IMAGING OF CORONARY ARTERY BYPASS GRAFT： A PRELIMINARY STUDY

Objective. To make a preliminary investigation of the patency and function of coronary artery bypass grafts (CABG) by magnetic resonance(MR) images and to establish a suitable method for follow-up study after CABG operation among Chinese. Methods. MR imaging was performed with a Toshiba 1.5-T unit in 27 patients with 74 grafts. All patients were examined with a breath-hold ECG-gated two-dimensional fast field echo (FFE) sequence to evaluate the patency of bypass grafts, among them 16 patients with 42 grafts were further examined with a phase shift magnetic resonance angiography flow (PSMRAflow) sequence to evaluate the grafts patency as well as the flow velocity and flow volume vs.time. Results. The results showed that 66 of the 74 grafts in the patients of the present series studied with FFE were patent with a patency rate of 89.2%. The results evaluated both with FFE and PSMRAflow remained the same except that two grafts were patent with FFE and the results with PSMRAflow were uncertain. Diastolic perfusion pattern curves were found in 25 of the 32 grafts in patients of the present series. Comparing the flow curves of the grafted left internal manmmry artery with those of the native right internal mammary artery in 7 patients, the systolic peak velocity value (SPV) of the grafted arteries was significantly lower than that of the ungrafted ones, whereas the diastolic peak velocity value(DPV) and the ratio of DPV to SPV were significantly greater than that of the ungrafed ones. Conclusion. The FFE and PSMRAflow sequences were efficient in evaluating patency and obtaining the curves of flow velocity and volume of the bypass grafts. Therefore, they may offer a non-invasive screening method for follow-up study in patients after CABG surgery, although its accuracy should be further evaluated in more patients and comparatively studied with other methods.     

不阻断主动脉冠状动脉搭桥术疗效分析

目的报道 10例不阻断升主动脉的冠状动脉搭桥术的疗效。　方法体外循环低温室颤冠脉搭桥术2例 ;非体外循环冠脉搭桥术 8例。其中三支病变 8例 ;双支和单支病变各 1例。前降支 10例 ,回旋支 6例 ,后降支 2例 ,左主干开口 2例 ,右冠脉 7例。移植血管 :左乳内动脉 7支 ;大隐静脉 2 0支。　结果　术后 1例死于慢性左心衰 ,9例存活 ,心绞痛消失。结论不阻断升主动脉的冠脉搭桥术创伤轻 ,死亡率低 ,并发症少 ,费用低 ,尤其非体外循环冠脉搭桥术更具优越性     

DSCT数字化血管成像对冠状动脉搭桥术后桥血管的评价

目的：探讨DSCT数字化血管成像对冠状动脉搭桥术后随访应用价值。方法：采用西门子DSCT（Siemens SOMATOM Definition）对16例行冠状动脉搭桥术后患者行DSCT冠状动脉检查,分别评价CT图像桥血管近远端吻合口、桥血管本身有无狭窄、钙化和吻合口远端引流血管的图像质量及冠状动脉图像质量,评价双源CT诊断桥血管通畅性和冠状动脉是否存在狭窄。结果：DSCT显示16例患者共发现桥血管42根,其中6根闭塞,所有桥血管均可评价。42支桥血管中,25支未见狭窄,9支桥血管狭窄程度≤50％,8支桥血管狭窄程度〉50％。搭桥血管通畅率为85．7％（36／42）,乳内动脉桥通畅率较高,为88．9％（8／9）,肱动脉次之,为85．7％（6／7）,大隐静脉桥通畅率最低,为76．9％（20／26）。结论：DSCT数字化血管成像作为一种无创性检查在冠状动脉桥血管随访的诊断和评价中是安全可靠的。     

MR IMAGING OF CORONARY ARTERY BYPASS GRAFT:A PRELIMINARY STUDY

Ｃｏｒｏｎａｒｙａｒｔｅｒｙｂｙｐａｓｓｇｒａｆｔ(ＣＡＢＧ)ｓｕｒｇｅｒｙｈａｓｂｅ ｃｏｍｅｉｎｃｒｅａｓｉｎｇｌｙｐｏｐｕｌａｒｉｎｏｕｒｃｏｕｎｔｒｙｉｎｒｅｃｅｎｔｙｅａｒｓ .Ｔｈｅｐｏｓｔｏｐｅｒａｔｉｖｅｓｅｌｅｃｔｉｖｅｃｏｒｏｎａｒｙｇｒａｆｔａｎｇｉｏｇｒａｐｈｙｒｅ ｍａｉｎｓｔｈｅ“ｇｏｌｄｓｔａｎｄａｒｄ”ｔｏｅｖａｌｕａｔｅｔｈｅｐａｔｅｎｃｙｏｆｔｈｅｇｒａｆｔ Ｈｏｗｅｖｅｒ ,ａｓａｎｉｎｖａｓｉｖｅｍｅｔｈｏｄａｎｄｆｏｒｏｔｈｅｒｒｅａ ｓｏｎｓ,ｉｔｉｓｎｏｔｗｉ…     

冠状动脉旁路移植术后桡动脉桥血管通畅率的影响因素分析

目的 分析冠状动脉旁路移植术(CABG)后桡动脉(RA)桥通畅率的影响因素。 方法 回顾性分析在CABG术中使用RA桥,并于术后1年复查冠状动脉计算机断层扫描血管造影术(CTA)患者65例。收集患者术前、术中及术后的相关资料,采用多因素logistic回归分析筛选RA桥通畅率的影响因素。 结果 RA桥靶血管近端狭窄程度≥80%(OR=0.212, 95%CI: 0.049~0.912, P=0.037)和靶血管在左前降支区域(OR=0.104, 95%CI: 0.012~0.921, P=0.042)是RA桥术后通畅率的独立保护因素,而术后未规范联用抗痉挛药物(OR=6.825, 95%CI: 1.857~25.083, P=0.004)是RA桥通畅率的独立危险因素。 结论 CABG术中RA桥靶血管的合理选择和术后联用抗痉挛药物是RA桥通畅率的独立影响因素。     

64层螺旋CT在冠状动脉旁路移植术后的诊断价值

目的探讨64层螺旋CT在冠状动脉旁路移植术后诊断桥血管及自体冠状动脉的临床价值。方法对术后2周～8年58例共140条桥血管（动脉桥43条,静脉桥97条）进行64层CT检查,以冠状动脉造影作为金标准,评价显著狭窄（管径狭窄〉50％）的桥血管及〉1．5inin管径的所有自体冠状动脉节段。结果140条桥血管中,38条闭塞,102条开通,CT全部诊断正确。102条开通的桥血管中,18条存在显著性狭窄,CT诊断敏感性100％,特异性95,2％。CT图像能够满足诊断的自体冠状动脉节段占90％。在可评价的冠状动脉节段中,以节段为单位诊断自体冠状动脉显著性狭窄的敏感性84％（87／103）、特异性74％（384／518）。临床正确诊断率为91％（53／58）。结论64层螺旋CT可准确诊断桥血管及自体冠状动脉的显著狭窄,是评价桥血管移植术后的一种无创、可靠的检查方法。     

双源CT血管造影评价冠状动脉旁路移植术后桥血管的价值

目的探讨双源CT血管造影（CTA）评价冠状动脉旁路移植术后桥血管的价值。方法对95例冠状动脉旁路移植术患者进行双源CTA检查,对所有图像进行后处理重建,包括最大密度投影（MIP）、曲面重建（CPR）、容积再现（VR）,评价桥血管的通畅情况或再狭窄程度。结果95例患者的CTA图像均符合诊断要求,清晰显示桥血管196支．其中动脉桥91支,静脉桥105支。有37支桥血管出现不同程度再狭窄,桥血管闭塞14支。结论双源CTA检查经各种后处理技术能清晰显示桥血管及冠状动脉本身,是评价冠状动脉旁路移植术后桥血管的一种准确可靠的无创检查方法。     

非体外循环下对多支冠状动脉病变的外科治疗

目的　为避免体外循环可为冠心病患者带来严重的并发症 ,本研究对一些选定的病例采用冠状动脉旁路移植术这一新的心肌血管重建技术 ,并证明该技术安全、有效。方法　选择 5 9例血管条件较好的患者接受非体外循环下多支冠状血管搭桥术 ,患者血管病变主要累及左冠状动脉 ,且大多伴有冠心病外科手术高危因素。平均搭桥 2 .7根。结果　早期结果 :手术死亡 1例 (1.7% ) ,手术转换 2例 (3.4 % ) ,“桥”失败 1例 (1.7% ) ,术后非致命性心肌梗塞 4例 (6 .8% ) ,肾功能衰竭 1例 (1.7% ) ,胸骨感染 1例 (1.7% ) ,接受输血 19例 (32 .3% )。早期随访情况 :死亡 2例 ,心绞痛复发 4例 ,充血性心功能衰竭 1例 ;术后均无脑血管意外、再次手术止血、室上性心律失常、下肢感染和呼吸衰竭等并发症。平均住院日减少 1.3d ,用血量减少 5 0 % ,住院费用减少 1/ 3。随访病例中行冠状动脉血管造影术 4 7例 ,其中仅 2 .6 %的血管桥狭窄大于 5 0 % ,所有胸廓内动脉血管桥均通畅。结论　对具有冠心病的外科手术高危因素、多支冠状动脉病变者 ,采用非体外循环下冠心搭桥术 ,可以降低术后并发症的发生率及手术死亡率。该技术仅适用于冠状动脉解剖条件较好的病例 ,且其远期结果需要长期随访证实     

Graft patency in off-pump and conventional coronary artery bypass grafting for treatment of triple vessel coronary disease

Inanattempttoavoidthedeleteriouseffectsofcardiopulmonarybypass (CPB) ,off pumpcoronarybypasssurgeryhasrecentlybeenrediscoveredandrefined Overthepastdecade ,theuseofoff pumporbeating heartcoronaryarterybypass (OPCAB)surgeryhassincebecomemorepopularandwidelyused Intriplevesseldisease ,accesstothelateralandposteriorwallvesselstofacilitatecompleterevascularizationevolved ,accompaniedbytechnicaladvancesintheinstrumentationforstabilizationoftheheart Multiplepreviousauthorshavereportedaseriesofoff…     

微创与常规静脉桥在冠状动脉旁路移植术中桥血管通畅率的对比观察

目的对比观察内窥镜及常规全程切开采集大隐静脉后静脉桥血管近期的通畅率。方法将2006-06～2010-12收治的80例搭桥患者随机分为内窥镜游离(EVH)组和常规切开采集(OVH)组,术后6个月复查64排冠脉CT,对比两组的静脉桥血管通畅率。结果 EVH和OVH组术后6个月静脉桥血管通畅率分别为94.7%和95.2%,两组比较无统计学差异(P>0.05)。结论内窥镜采集的大隐静脉近期内有良好的桥血管通畅率。     

心脏退行性瓣膜病合并冠心病同期手术治疗

目的:总结老年退行性瓣膜手术和冠状动脉旁路移植术(CABG)同期施行的效果和临床经验。方法:2011年1月-2012年12月同期行退行性瓣膜手术与冠状动脉旁路移植术的老年患者63例,其中男37例,女26例,年龄60～72岁,平均年龄(65±4)岁。退行性瓣膜疾病合并冠心病42例,冠心病合并退行性瓣膜病21例。同期行冠状动脉旁路移植术合并瓣膜置换58例,其中双瓣膜置换5例,合并三尖瓣成形术15例,合并带瓣人工血管置换(Bentall)手术1例,合并室壁瘤切除术1例,合并左房血栓清除术2例;合并单瓣膜成形术7例。冠状动脉造影显示单支血管病变15例,双支16例,多支32例。结果:本组早期病死3例(4.8%),共出现并发症8例(12.7%);患者中2例死于重症感染引发的多器官功能衰竭,1例死于低心排综合征。低心排综合征2例,再次开胸止血3例,呼吸衰竭2例,室颤1例,脑栓塞2例均治愈。手术后随访43例,随访时间1～60个月,随访期间无死亡,患者生活质量明显改善。结论:老年患者退行性瓣膜手术及冠状动脉旁路移植术同期施行手术效果满意,具有安全可行性。     

左主干行冠状动脉旁路移植手术中远期效果分析

目的 总结2002~2008年行冠状动脉旁路移植手术的冠心病左主干患者远期桥血管通畅率。 方法 2002~2008年冠心病左主干患者行冠状动脉旁路移植术共73例,男性57例,女性16例,患者年龄65.7±8.1岁。包括心肌梗死31例、左心室室壁瘤11例,合并瓣膜病变4例,术前使用主动脉气囊反搏(IABP)5例。行急诊冠状动脉旁路移植术共5例,冠状动脉旁路移植术+瓣膜置换术共4例,冠状动脉旁路移植术+室壁瘤切除并左心室成形术共6例,机器人冠状动脉旁路移植术1例。其中体外循环下手术65例,非体外循环手术8例。左乳内动脉与左前降支吻合,大隐静脉与靶血管吻合,静脉吻合口超过两个(含)时做序贯吻合。术后随访行冠状动脉64-CT或冠状动脉造影复查桥血管通畅率。 结果 术后死亡2例(病死率2.7%),死因分别为恶性心律失常和多器官衰竭。痊愈出院71例,随访患者53例,失访18例,随访率74.6%,随访时间4个月~11年,平均随访时间73.2±30.2个月。随访期间死亡8例,其中3例为心源性死亡,心源性病死率5.7%,余者为其他疾病死亡。10例再发心绞痛,2例心肌梗死,2例脑梗死。 39例患者行桥血管CT或造影,动脉桥通畅率97.4%,静脉桥通畅率82.8%。 结论 冠心病左主干患者病情重,行冠状动脉旁路移植术可有效改善冠脉血运,远期效果良好。     

ANGIOGRAPHIC STUDY ON THE PATENCY OF SINGLE VERSUS SEQUENTIAL VENOUS GRAFT BEFORE REDO CORONARY ARTERY BYPASS SURGERY

Objective To compare the long-term patency and longevity of the single and sequential ve-nous graft. Methods The coronary arterial angiographic data for 300 redo coronary bypass grafting (CABG) were collected. Among them 106 cases had both single (159) and sequential (118) grafts. Results The oc-clusive and narrowness rate for the single grafts versus sequential grafts were: 1 year, 2% vs 2% ; 5 years, 3% vs 4% ; 10 years, 18% vs 19% ; 15 years, 60% vs 68% ; and 23 years, 76% vs 81% , respectively. The differences were not significant in general. Conclusion Sequential anastomosis itself does not has any adverse affects on short-term and long-term patency of the venous graft and its longevity in CABG operations in general.     

快速傅里叶变换分析冠状动脉旁路移植术中不同桥血管的血流波形特征及其意义

基于血流频谱特征探讨冠状动脉旁路移植术（CABG）中左侧乳内动脉（LIMA）、大隐静脉（SVG）、乳内动脉+大隐静脉复合桥（LIMA+SVG）和桡动脉（RA）术后通畅率上存在差异的原因,阐明其临床意义及应用价值。