老年人冠状动脉起源异常研究

目的 分析老年人冠状动脉起源异常的类型及检出率,总结其冠状动脉分布的优势情况,并探讨冠状动脉起源异常与冠状动脉粥样硬化的关系.方法 回顾性分析北京大学第一医院接受冠状动脉造影检查的老年患者资料,记录冠状动脉起源异常的检出频度和类型,及发生冠状动脉粥样硬化性狭窄的情况.结果 冠状动脉造影总数2031例,检出冠状动脉起源异常46例(2.3%).右冠状动脉起源异常26例(56.5%),右冠状动脉起源异常多于左冠状动脉(19例,41.3%).其中以右冠状动脉起源于左冠状动脉窦为最常见类型,占总异常的28.3%(13例).并存冠状动脉粥样硬化性狭窄者37例(80.4%),其中17例(37.0%)累及起源异常的冠状动脉.结论 我国老年人冠状动脉起源异常多见于右冠状动脉,其中具有潜在临床危险的右冠状动脉起源于左冠状动脉窦为最常见类型.冠状动脉起源异常与冠状动脉粥样硬化存在相关性.

Abstract：

Objective To estimate the patterns and frequency of anomalous coronary origin with angiography in the Chinese elderly population and evaluate the correlation between anomalous coronary origin and development of coronary atherosclerotic stenosis. Methods A retrospective analysis was performed on the basis of angiographic data among elderly patients who underwent coronary arteriography in Beijing University First Hospital. Those with anomalous origin of coronary arteries were selected for further assessment and significant stenosis in coronary arteries was recorded.Results Among 2031 patients, 46 patients were found to have anomalous origin of coronary artery,with an incidence rate of 2.3%. Right coronary artery was the most common anomalous vessel, being involved in 26 patients (56.5%). The anomalous origin was more frequent in right coronary artery than in left coronary artery (41.3%). The most common anomaly was right coronary artery arising from left coronary sinus in 13 patients (28.3%). Significant atherosclerotic lesions in the anomalous arteries were seen in 37 patients (80.4%). Conclusions In Chinese elderly population, the anomalous origin of coronary artery is more frequent in right coronary artery, the most common anomaly resides in right coronary artery arising from left coronary sinus. The anomalous coronary artery increases risk for development of coronary atherosclerotic stenosis.     

阻塞性冠心病验前概率模型的研究进展

有创冠状动脉造影(invasive coronary angiography, ICA)是稳定性冠状动脉粥样硬化性心脏病(stable coronary artery disease, SCAD)的诊断金标准,但作为一种有创检查,存在着不小的并发症风险.多项大型、前瞻性研究已经证明冠状动脉CT造影(coronary c...     

SYNTAX积分临床应用进展

<正>作为第一个比较药物洗脱支架(drug eluting stents,DES)TAXUS支架与冠状动脉旁路移植术(coronary artery bypass graft,CABG)治疗三支病变和(或)无保护左主干病变的前瞻、多中心、随机、对照的临床研究,SYNTAX研究已经成为DES时代比较经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)和CABG治疗冠状动脉多支病变     

血流储备分数指导冠状动脉旁路移植术的现状与探索

<正>长久以来,对于冠状动脉旁路移植术(coronary artery bypass grafting,CABG)的实施主要是根据冠状动脉造影(coronary angiography,CAG)检查,由心外科医生根据造影结果进行评估,判断狭窄病变的严重程度并决定需要手术处理的狭窄冠状动脉病变位置~([1])。目前外科冠状动脉血运重建指征是左主干直径狭窄≥50%或者3支主要冠状动脉狭窄≥70%~([1])。然而,在所有冠状动脉解剖狭窄中,约有40%的形态     

心脏外科手术后卒中

卒中是心脏外科手术后最具破坏性的并发症之一,可导致患者死亡和残疾.冠状动脉旁路移植术(coronary artery bypass graft,CABG)和经皮冠状动脉介入术(percutaneous coronary intervention,PCI)是治疗冠状动脉疾病的常用手术.文章对CABG和PCI后卒中的病理生理学机制、危险因素、治疗和预后进行了综述.     

川崎病患者选择性冠状动脉造影单中心特点及经验分析

目的 总结昆明市儿童医院川崎病并发严重冠状动脉病变(coronary artery lesion,CAL)患者选择性冠状动脉造影(coronary angiography,CAG)的特点及经验.方法 回顾性分析2017年7月至2019年10月在昆明市儿童医院行CAG的32例川崎病患儿临床资料,男23例,女9例,年龄5岁...     

冠状动脉血流储备分数研究进展

<正>目前,全球范围内冠状动脉心脏病(coronary artery disease,CAD)发病率和病死率居高不下[1]。一直以来,冠状动脉造影(coronary angiography,CAG)被认为是诊断CAD的"金标准"。然而,随着对冠状动脉血流动力学和病理生理学研究不断深入,发现CAG在评价冠状动脉狭窄病变解剖特征和生理功能等方面也存在不足。血流储备分数(fractional     

积极稳妥推进老年冠心病的介入治疗

<正> 我国冠心病发病率仍呈上升趋势,而老年冠心病占其总数的64%～87%,成为我国致残率和致死率最高的疾病之一,故对其进行准确的诊断和及时有效的治疗,已为人们所重视。目前冠心病治疗主要有药物疗法、经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)和冠状动脉旁路移植术(coronary artery bypass graft,CABG)3种。     

系统性血管炎合并冠心病患者的冠状动脉病变及临床特征

目的 阐述系统性血管炎合并冠状动脉病变患者的临床和冠状动脉病变特征.方法 对北京协和医院1999年1月至2009年10月有冠状动脉造影结果的15例系统性血管炎合并冠心病患者的临床表现及冠状动脉病变进行回顾性分析.结果 15例患者中,贝赫切特综合征(BS)6例、变应性肉芽肿性血管炎(CSS)3例,大动脉炎2例,结节性多动脉炎(PAN)、显微镜下多血管炎(MPA)、Wegener肉芽肿(WG)和川崎病各1例.15例患者出现冠心病表现的平均年龄(39.3±11.9)岁.与在血管炎非活动期出现冠状动脉事件的患者(4例)相比,在血管炎活动期出现冠状动脉事件的患者(9例)有以下趋势:发病年龄小[(32.4±8.1)岁比(47.0±10.2)岁],传统冠心病危险因素少[(1.2±1.5)个比(2.8±1.7)个],血管炎和冠心病发病间隔短[0～7(平均1.6)年比3～30(平均17.7)年].15例患者中,表现为急性心肌梗死12例,心绞痛2例,心包填塞1例;3例发生急性冠状动脉事件时合并严重心律失常,3例合并急性左心功能不全.冠状动脉造影检查8例患者表现为冠状动脉狭窄、闭塞,1例表现为动脉瘤及急性血栓形成,1例表现为多发冠状动脉瘤样扩张伴闭塞,2例表现为冠状动脉痉挛,另有3例急性心肌梗死患者冠状动脉狭窄程度＜70%.8例患者超声心动图检查左心室射血分数＜50%.结论 多种系统性血管炎可合并冠状动脉病变,临床上可以表现为危急重症,冠状动脉狭窄或闭塞、动脉瘤形成、痉挛、急性血栓形成和小血管病变共同参与发病.

Abstract：

Objective To evaluate the clinical and coronary angiographic features of patients with systemic vasculitis and coronary artery disease. Method Fifteen patients ( 11 male) with systemic vasculitis and coronary artery diseases admitted to our hospital from January 1999 to October 2009 were reviewed. Results There were 6 patients with Behcet's disease, 3 patients with Churg-Strauss syndrome, 2 patients with Takayasu arteritis, 1 patient with polyarteritis nodosa, 1 patient with microscopic polyangiitis, 1 patient with Wegner's granulomatosis and 1 patient with Kawasaki disease. Mean age of this cohort was (39. 3 ± 11.9) years. Adverse coronary events occurred in 4 patients during the inactive phase of systemic vasculitis and in 9 patients during the active phase of systemic vasculitis. Twelve patients were hospitalized with acute myocardial infarction, 2 with angina pectoris and 1 with cardiac tamponade. There were 3 patients with acute left ventricular dysfunction and 3 patients with severe arrhythmias. Compared to patients in the inactive phase, patients in the active phase were younger [(32. 4 ± 8. 1 )years vs. (47.0 ± 10. 2)years],had less risk factors for atherosclerosis ( 1.2 ± 1. 5 to 2. 8 ± 1.7) and the time intervals between coronary artery disease and systemic vasculitis was shorter [0 -7 years( average 1.6 years) to 3 -30 years( average 17.7 years)]. Coronary angiography evidenced coronary stenosis or occlusions in 11 patients, coronary aneurysm and acute thrombosis in 1 patient, coronary aneurysms and occlusions in 1 patient and coronary spasm in 2 patients. LVEF measured by eehocardiography was less than 50% in 8 patients. Conclusion Patients with various systemic vasculitis could develop severe coronary artery disease due to coronary stenosis/occlusion, aneurysma, thrombosis and coronary spasm.     

血管内超声指导冠状动脉左主干介入治疗

在临床实际工作中,诊断冠状动脉(冠脉)左主干(left main coronary artery,LMCA)病变即意味着患者属于高危人群,约占冠脉造影确诊冠心病的4％[1].在单纯药物治疗时代,LMCA病变预后很差, 5年死亡率可高达43％[2].和单纯药物治疗相比,冠脉旁路移植术(coronary artery by...     

冠状动脉穿孔的特点及主要治疗策略

<正>冠状动脉穿孔(coronary artery perforation, CAP)是经皮冠状动脉介入(percutaneous coronary intervention,PCI)及其严重的并发症，发生率0.2%～0.5%，多发生在慢性冠状动脉完全闭塞病变(chronic total coronary occlusion,CTO)介入、严重钙化病变等复杂病变介入治疗术中^[1-3]。本文就CAP的治疗策略的现状进行综述。一、冠状动脉穿孔的分型CAP根据其发生的部位，如大血管、末端血管、室间隔或心外膜侧支穿孔等，分为三类：大血管穿孔型、末端血管穿孔型及侧枝穿孔型。大血管穿孔型CAP的常见的原因包括使用大规格球囊或者支架，高膨胀压力，     

超声随访川崎病并发冠状动脉病变的3年分析

目的 探讨川崎病并发冠状动脉病变患儿的预后,为进一步探索川崎病引起心血管损害后期的诊断治疗提供依据.方法 选取2002年1月至2007年6月在桂林医学院附属医院、广西壮族自治区第二人民医院及桂林市妇女儿童医院诊断为川崎病并发冠状动脉损害的患儿为研究对象.所有纳入者均于急性期出院后3、6个月和1、2、3年各随访超声心动图1次,观察冠状动脉形态.依据发病时冠状动脉损害严重程度分为冠状动脉轻度扩张组、中等动脉瘤组和巨大冠状动脉瘤组,对其病变恢复情况进行比较.结果 冠状动脉轻度扩张组84例,中等动脉瘤组27例,巨大冠状动脉瘤组8例获得随访.随访3个月,3组恢复例数分别为23例(27%)、3例(11%)、0;6个月时分别为44例(52%)、8例(30%)、0;1年时分别为69例(82%)、13例(48%)、1例(13%);2年时分别为78例(93%)、19例(70%)、3例(38%);3年时分别为82例(98%)、20例(74%)、4例(50%).其中13例行三磷酸腺苷(ATP)负荷超声心动图检查,5例行冠状动脉造影,4例行 64排CT冠状动脉重建,发现部分病例存在冠状动脉狭窄或冠状动脉闭塞.结论 川崎病最常见的是冠状动脉扩张,轻度冠状动脉扩张多见且多是暂时性的,通常在治疗后能恢复.巨大冠状动脉瘤比例低,但恢复时间长,后期可发生冠状动脉狭窄或闭塞,导致缺血性心脏病概率更高.对于川崎病,尤其是冠状动脉病变严重者应加强随访,及时干预治疗,以期改善预后.

Abstract：

Objective To investigate the prognosis of patients with Kawasaki's disease complicated with coronary artery lesion and to provide evidence for diagnosis and treatment of these patients. Methods This study was conducted during January 2002 to June 2007. All patients diagnosed as Kawasaki's disease complicated with coronary artery lesions were from the Affiliated Hospital of Guilin Medical College, the Second People's Hospital of Guangxi Province and Guilin Women and Childrens' Hospital. All cases were echocardiogram examined in month 3, 6, 12, 24 and 36 in the purpose of observing the morphology of coronary artery. The study subjects were re-categorized to the groups of mild, moderate dilatation of coronary artery and giant coronary aneurysm, based on the severity of coronary artery lesion. The results of these results of the three groups were compared. Results Eighty-four cases in the mild group, 27 cases in the moderate group and 8 cases in the giant coronary aneurysm. The recovery cases were 23 (27%), 3 (11%) and 0 in the 3 groups respectively at month 3. The above numbers were 44 (52%), 8 (30%) and 0 respectively at month 6.The numbers were 69(82%), 13 (48%) and 1 (13%) at month 12. The numbers were 78 (93%), 19 (70%), 3 (38%) at month 24. The numbers were 82(98%), 20(74%) and 4(50%) at month 36. Thirteen patients were treated with adenosine-triphosphate (ATP) stress echocardiography examiantion, 5 patients were evaluated by coronary angiography,and 4 patients were tested by 64-slice CT coronary reconstruction. Part of the patients were found to have coronary stenosis or occlusion. Conclusion Patients of Kawasaki's disease often have concurrent coronary artery lesions. Patients with mild dilatation of the coronary artery are the most commonly seen and have the best prognosis. On the contrast, patients with giant coronary aneurysm are the lest common situation and is the worst in prognosis. Part of them will develop coronary artery stenosis or occlusion in late stage which may lead to ischemic heart disease. We should stress on close follow-up of patients with Kawasaki's disease complicated with coronary artery lesion. Appropriate and timely treatment will increase their clinical outcomes.     

综合康复对冠状动脉旁路移植术后患者运动耐力及心理状况的影响

<正>随着冠心病临床治疗各种方法如经皮冠状动脉介入治疗及冠状动脉旁路移植术(coronary artery by-pass aft,CABG)的广泛应用,冠心病患者的病死率已明显降低。继而人们更加关注术后心理状况及生活     

从自发性冠状动脉夹层到动脉壁内血肿1例

自发性冠状动脉夹层(spontaneous coronary artery dissection,SCAD)常见于无冠状动脉粥样硬化危险因素的年轻女性,多表现为急性冠脉综合征(acute coronary syndrome,ACS),需要紧急行冠状动脉造影(coronary angiography,CAG)并结合血管内超声(intravascular ultrasound,IVUS)或光学相干断层扫描(optical coherence tomography,OCT)影像检查明确,给予药物治疗、经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)或外科治疗.本文以1例SCAD患者2次诊治经过为背景,讨论了SCAD的病因、发病机制、临床表现、诊断及治疗策略.     

CABG同期二尖瓣置换与二尖瓣成形术治疗冠心病合并Ⅲb型缺血性二尖瓣反流患者的疗效比较

目的 对比分析冠状动脉旁路移植术(coronary artery bypass grafting,CABG)同期行二尖瓣置换术(mitralvalve replacement,MVR)与二尖瓣成形术(mitral valvuloplasty,MVP)治疗冠状动脉粥样硬化性心脏病(冠心病)合并Ⅲb型缺血性二尖瓣反流(is...     

冠状动脉瘘的CT血管成像表现

目的 分析冠状动脉瘘的CT血管成像表现.方法 回顾性分析12717例行冠状动脉多排螺旋CT血管成像检查病例,其中诊断冠状动脉瘘66例.综合多种后处理图像,记录冠状动脉瘘的起源、瘘口、冠状动脉有无斑块及狭窄.其中14例患者行冠状动脉造影,比较两种检查方法结果的异同.结果 66例冠状动脉瘘中,起源于双侧冠状动脉21例,左冠状动脉26例,右冠状动脉19例;而瘘口在肺动脉41例,左心房10例,右心房8例,左心室4例,冠状静脉2例,右心室1例.14例患者冠状动脉造影显示的瘘管起源和瘘口部位均与多排螺旋CT血管成像一致.31例冠状动脉瘘同时伴冠状动脉斑块形成,其中狭窄程度≥50%者7例.结论 双侧冠状动脉起源的冠状动脉瘘并不少见,且瘘口在肺动脉者最多.CT血管成像可作为冠状动脉瘘的首选检查手段,可为该病的治疗提供重要的术前信息.

Abstract：

Objective To analyzed the computed tomography angiography (CTA) features of the coronary artery fistulas. Methods Sixty-six coronary artery fistulas were diagnosed out of 12 717 patients underwent the coronary artery multiple detector CTA examination. The origin and drainage site of the coronary artery fistulas and the plaque and stenosis of the coronary artery were observed by post-processing analysis on various images. Coronary artery angiography was performed in 14 out of 66 coronary artery fistulas patients. Results Coronary artery fistulas arose from bilateral coronary artery system in 21 cases, from left coronary artery in 26 cases and from right coronary artery in 19 cases. The majority of coronary artery fistulas entered into pulmonary artery (41 cases). The rest drainage sites included left atrium (10 cases), right atrium (8 cases),left ventricle (4 cases), coronary sinus (2 cases) and right ventricle (1 case). The findings of CTA and coronary artery angiography were consistent in 14 patients with DSA examination. Coronary artery plagues were evidenced in 31 cases and stenosis was greater than 50% in 7 coronary artery fistulas patients. Conclusions Multiple coronary artery fistulas are not rare, and pulmonary artery is the most frequent drainage site. When suspecting the coronary artery fistulas, coronary artery CTA can be the first choice of diagnose. CTA can supply adequate information for therapy.     

先天性单支左冠状动脉并急性冠脉综合征介入治疗2例报告

单支冠状动脉(single coronary artery,SCA)是指冠状动脉以单一开口起源为整个心脏提供血液供应,属于罕见的先天性冠状动脉畸形。SCA是具有潜在危险的冠状动脉畸形,是心绞痛、心肌梗死,甚至猝死的罕见病因。本文报道2例SCA并急性     

CT血流储备分数对冠心病诊疗的指导价值

有创冠状动脉造影(invasive coronary angiography,ICA)是评价冠状动脉疾病(coronary artery disease,CAD)的重要标准.介入医生通过ICA对冠状动脉狭窄的严重程度进行目测评估,决定是否采取血运重建治疗措施.然而,目测的狭窄严重程度与下游心肌缺血情况相关性较差,仅根据...     

320排动态容积CT冠状动脉成像与心肌灌注成像的相关性研究

目的探讨320排动态容积CT冠状动脉成像(computed tomography coronary angiography,CTCA)显示的冠状动脉狭窄程度与CT心肌灌注成像(CT myocardial perfusion imaging,CT-MPI)显示的心肌灌注缺损之间的相互关系。方法对60例冠状动脉疾病患者行CTCA及CT-MPI检查,将其结果进行统计学处理,并进行Spearman等级相关分析。结果 CTCA显示冠状动脉左前降支(left anterior descending,LAD)、左回旋支(left circumflex artery,LCX)、右冠状动脉(right coronary artery,RCA)180支,其中正常冠状动脉56支,狭窄冠状动脉124支。按照LAD、LCX、RCA三支冠状动脉供血范围统计,CT-MPI显示86支冠状动脉灌注正常,94支冠状动脉存在灌注缺损。结论冠状动脉狭窄程度与心肌灌注缺损存在正相关的关系。     

重症冠心病的非体外循环下冠状动脉旁路移植术

目的 探讨如何提高莺症冠心病患者非体外循环下冠状动脉旁路移植术的手术疗效.方法 Off-Pump coronary artery bypass grafting of severe coronary artery disease回顾性分析268例重症冠心病患者非体外循环下冠状动脉旁路移植术的临床资料,男性131例,女性137例;搭桥数2～6(4.01±0.99)支/人.对手术方法、主要并发症和术后处理进行分析总结.结果 二次开胸3例(1.1%),低心排综合征9例(3.4%),应用IABP 1例(0.4%),反复发作房颤22例(8.2%),肺功能不全13例(4.9%);死亡2例(0.7%),其余患者康复出院.结论 合理地选择患者、成熟的手术技术、主动脉内球囊反搏(IABP)的尽早应用及术后处理的加强是提高重症冠心病患者非体外循环下冠状动脉旁路移植术疗效的重要措施.