冠状动脉扩张发病相关因素的研究进展

冠状动脉扩张可定义为冠状动脉局限性或弥漫性扩张,是包括动脉粥样硬化、系统性血管炎症、结缔组织病、先天性异常、感染、中毒、局部损伤、基因异常等众多原发病引起的一种病理过程,是在各种物理、化学及生物学因子的作用下,冠状动脉中层结构和功能削弱,血管壁异常变薄形成的,其发病机制尚不清楚。本文综述近年来冠状动脉扩张发病相关因素的研究进展。     

冠状动脉瘤样扩张

本文介绍冠状动脉瘤样扩张的病因，诊断，临床意义和治疗方法。     

冠状动脉瘤样扩张的研究进展

随着冠状动脉CT血管成像、核磁共振成像及介入术治疗的推广,有关冠状动脉瘤样扩张的报道逐渐增多。常见病因有动脉粥样硬化、川崎病等,但其发病机制尚不完全清楚,选择优化的治疗方案仍具有争议。现介绍冠状动脉瘤样扩张的流行病学、病因、发病机制、临床表现与诊断及治疗方案。     

冠状动脉瘤样扩张与缺血性心脏病的关系

目的　探讨冠状动脉瘤样扩张与缺血性心脏病的关系。方法　常规方法行选择性冠状动脉造影。缺血性心脏病的临床诊断按Ｗ ＨＯ 标准。结果　共发现３２ 例冠状动脉瘤样扩张,其中１７ 例为单纯冠状动脉扩张,１５ 例为冠状动脉扩张并狭窄。１１ 例并有心肌梗塞,１７ 例心绞痛,５ 例为非典型胸痛。结论　部分缺血性心脏病可能由冠状动脉瘤样扩张所致     

双源CT血管成像对冠状动脉瘤样扩张的诊断价值

<正>冠状动脉瘤样扩张(coronary artery aneurysmal ectasia,CAE)是指心外膜下冠状动脉的局限性或者弥漫性扩张,其管径扩张超过邻近正常冠状动脉管径的1.5~2倍~([1]),部分以心绞痛、ECG改变、心力衰竭及急性心肌梗死为主要临床表现,由于其存在瘤体破裂、心包填塞等风险,威胁着患者的生命,因此利用影像技术对冠状动脉瘤样扩张进行早期诊断,以及术前评估具有重要意义。本文通过对行双源CT冠状动     

冠状动脉瘤样扩张的临床特点

目的 探讨冠状动脉瘤样扩张的临床特点及治疗方法。方法 对冠状动脉造影发现的186例冠状动脉瘤样扩张患者询问胸痛病史，检查心电图、X线胸片、超声心动图、冠状动脉造影等，并对治疗方法与结果做回顾性总结分析。结果 冠状动脉瘤样扩张表现为心绞痛的病例有147例，占79．0％，心电图、X线胸片、超声心动图均无特异性，186例均由冠状动脉造影确诊。结论 心绞痛为冠状动脉瘤样扩张的主要临床表现，冠状动脉造影是确诊的主要方法。本病一旦确诊应积极、长期使用抗凝剂和血管扩张药物，防止冠状动脉痉挛与心肌梗死的发生。急性心肌梗死应积极溶栓，药物治疗不满意者，应行冠状动脉旁路移植术。     

冠状动脉瘤样扩张的识别与诊断

目的 探讨冠状动脉瘤样扩张的特点,提高识别与诊断能力.方法 对我院11例冠脉造影检查证实的冠状动脉瘤样扩张患者进行症状询问,心电图、心肌酶学、X线胸片、超声心动图检查.结果 2例表现为急性心肌梗死,7例心绞痛,2例非典型胸痛.造影显示11例冠状动脉瘤样扩张直径达6～10 mm,其中右冠状动脉(RA)7例,左前降支(LAD)4例,左回旋支(LCX)3例;2例扩张血管内血栓形成.结论 冠脉以单支血管瘤样扩张为主,右冠多见,其临床表现与冠心病高度相似,冠状动脉影像学检查可尽早确诊.     

支架置入术后冠状动脉瘤样扩张的临床研究

目的分析冠脉支架置人术后冠状动脉瘤样扩张的临床特点。方法支架置人术后半年至2年复查冠脉造影的患者,筛选支架处动脉瘤样扩张患者,分析易患因素,并对患者进行随访。结果1209例患者于支架术后复查冠脉造影,有11例发现发生了支架相关冠状动脉瘤样扩张。其中8例为男性（8／1209）,9例为药物支架（9／1209）,发生在前降支者6例（6／1209）,右冠脉者5例（5／1209）。对发生动脉瘤患者进行随访,在平均18个月（9～25个月）的随访中,发生1例因心绞痛住院,1例冠状动脉瘤样扩张患者在16个月后再次复查造影,动脉瘤样扩张消失。结论支架置入术后冠状动脉瘤样扩张总体发生率低,远期预后良好。     

冠状动脉瘤样扩张的研究进展

冠状动脉瘤样扩张首次报道于 1983年[1,2 ] ,随着冠状动脉造影技术及冠脉介入治疗的推广普及 ,有关冠状动脉瘤样扩张的报道逐年增多 ,但是冠状动脉瘤样扩张发生的机制及其对人体的影响尚未清楚 ,本文就近年来冠状动脉瘤样扩张的病因、发病机理、治疗及预后等作一综述。1　冠状动脉瘤样扩张的定义冠状动脉瘤样扩张是指冠状动脉局部或弥漫性扩张。多数学者赞同冠状动脉瘤样扩张指冠状动脉局部管径扩大超过邻近正常段或其管径大于正常值上限的1.5倍[3 7] 。管径的测量有两种方法 ,即ＱＣＡ系统(Ｑｕａｎｔｉｔａｔｉｖｅｃｏｒｏｎａｒｙａｎ…     

冠状动脉-上腔静脉瘘合并瘤样扩张致心绞痛1例

<正>1病例资料患者,女,62岁,因"间断心前区疼痛8年,加重4个月"入院。8年前无明显诱因出现心前区疼痛,呈针扎样痛,无大汗、颈部紧缩感、肩背部及左上肢放射痛,此后上述症状间断发作,每次持续数秒钟后自行缓解,未行相关治疗。4个月以来心前区疼痛较前加重,持续时间延长,伴心悸、气促,遂至我院就诊。入院后体检:T 36.5℃,P 69次/min,R18次/min,BP 132/78 mmHg(1 mmHg=0.133     

Two-Dimensional Echocardiographic Identification of Peripheral Coronary Artery Ectasia in an Adult

Coronary artery aneurysms (ectasia) have been reported to be present in up to 4.9% of patients undergoing coronary angiography. In children with Kawasaki's disease or coronary arteriovenous fistula, the transthoracic two-dimensional echocardiographic findings associated with peripheral vessel aneurysms have been previously described. Echocardiographic imaging of peripheral coronary artery segments in the adult is difficult and to date only imaging of large, proximal coronary artery aneurysms has been reported. We report a case of an adult patient with angiographically documented extensive right coronary artery ectasia in which peripheral vessel aneurysms were identified with transthoracic echocardiography.     

冠状动脉扩张的研究进展

冠状动脉扩张是临床较为常见的冠状动脉疾病,冠状动脉造影是主要的诊断手段,目前该病的发病机制仍不清楚,有学者提出一氧化氮对血管内皮的过度刺激、炎症假说等可能参与发病。该病常合并冠状动脉粥样硬化性心脏病,因此冠状动脉粥样硬化性心脏病的一级和二级预防措施同样适用于冠状动脉扩张患者,硝酸酯类药物能导致患者病变血管的进一步扩张,加重心肌缺血,因此不推荐应用。     

Mitral Valve Prolapse (MVP) and Coronary Artery Ectasia

A case of isolated ectasia of the entire right coronary artery and mitral valve prolapse is reported. The patient presented with acute inferior myocardial infarction and progressive angina pectoris. The diagnosis of ectasia of the right coronary artery and mitral prolapse was established angiographically. During a two-year follow-up period, the patient has continued to have angina and has suffered a second inferior myocardial infarction. Subsequent angiographic reevaluation has failed to show occlusive coronary lesions. It is suggested that distal thromboembolism due to changes in the character of blood flow in the dilated vessel has been responsible for the two episodes of myocardial infarction and persistent angina pectoris.     

Assessment of Coronary Flow Parameters by Transesophageal Echocardiography in Patients with Isolated Coronary Artery Ectasia: Effect of Intravenous Nitroglycerin

Background: We sought to assess coronary flow parameters in patients with isolated coronary artery ectasia (CAE) as compared to subjects with normal coronaries. Methods: Consecutively, we enrolled 30 patients with ectasia of the left anterior descending (LAD) coronary artery (study group), and 10 subjects with normal coronaries (control group). All patients underwent transesophageal echocardiography to visualize the LAD. Spectral recordings of proximal LAD flow velocities were made and velocity time integrals were calculated. The diameter of the proximal LAD was measured and LAD blood flow was calculated. Nitroglycerin (0.3 mg) was administered intravenously and measurements were repeated 5 minutes later. Results: The mean age of the whole series was 48.6 ± 8 years, 39 (97.5%) being males. A significantly higher baseline systolic, diastolic, and total coronary blood flow was found in the study group as compared to the control group (46.1 ± 34.3 vs. 23.1 ± 8.2, 123.9 ± 73.3 vs. 68.1 ± 21.6, 170.1 ± 97.9 vs. 91.1 ± 26.8 cm³/min, respectively, P < 0.05 for all). Within the study group, nitroglycerin administration caused a significant decrease in peak diastolic velocity; systolic, diastolic, and total velocity time integrals; and both diastolic and total coronary blood flow (P < 0.05 for all). Meanwhile, within the control group, nitroglycerin administration caused a significant increase in the total coronary blood flow (P < 0.05). Conclusions: Patients with CAE have higher resting coronary blood flow in comparison with subjects with normal coronaries. Intravenous nitroglycerin administration causes significant reduction of coronary blood flow in ectatic coronary arteries. (Echocardiography 2010;27:1004‐1010)     

Multiple Coronary Artery Aneurysms of the Right Coronary Artery in Neonate with Pulmonary Atresia with Intact Ventricular Septum

Pulmonary atresia with intact ventricular septum (PA/IVS) with right ventricular‐dependent coronaries is a rare congenital cardiac anomaly. It has been associated with wide range of considerable anomalies including sinusoids, fistulae, coronary stenosis, or complete atresia. Coronary artery aneurysms in a neonate with PA/IVS have not been described. We report a case of neonate with pulmonary atresia with intact ventricular septum with giant coronary artery aneurysms.     

冠状动脉扩张症患者的临床特征及新分型指导介入治疗的效果观察

目的:总结51例冠状动脉扩张症(CAE)患者新分型临床特点及指导介入治疗的临床疗效.方法:回顾性分析我院2015年1月至2019年1月出院诊断含CAE且冠状动脉造影结果均符合CAE诊断标准患者51例.收集临床资料,按CAE新分型分类,随访主要不良心血管事件(MACE),其定义为全因死亡、心原性死亡、心肌梗死、血运重建的...     

Coronary Artery Ectasia in Atherosclerotic Coronary Artery Disease,Inflammatory Disorders,and Sickle Cell Disease

Coronary artery ectasia (CAE) or aneurysm is usually defined as dilation ≥1.5‐fold the normal vessel diameter. It has an incidence of 1.4–5.3% and is associated with a wide variety of etiologies—mainly congenital, atherosclerotic, and inflammatory ones. CAE is very common in sickle cell disease, and possibly sickle cell trait, with an incidence of 17.7%. It is likely related to the inflammatory process associated with hemoglobin S. Prognosis depends mainly on the underlying etiology. Atherosclerotic CAE does not carry additional risks compared to atherosclerotic coronary artery disease (ACAD) without ectasia. However, isolated CAE in the absence of ACAD carries an increased risk of myocardial infarction (MI) due to vasospasm, slower coronary blood flow, and thrombosis, typically within the dilated segments. Due to lack of studies and guidelines, management recommendations are based on personal experiences. Therapy should be tailored to each individual case after assessment of severity, history of complications, underlying etiology, and comorbidities. Treatment of underlying condition and avoidance of exacerbating factors are essential. Medical therapy in general may include antiplatelets, β‐blockers, angiotensin‐converting enzyme inhibitors statins, and dihydropyridine calcium channel blockers. In severe CAE or history of MI, the addition of anticoagulation therapy after assessing bleeding risk may be warranted. In acute MI, the large thrombus burden in the dilated segment makes the percutaneous approach very challenging. Aspiration attempts can result in distal thromboembolization. Survival is better in bypass grafting than with medical therapy. Nonetheless, bypass grafting does not improve survival in atherosclerotic CAE. Depending on the physical characteristics of aneurysm, different surgical approaches can be sought; however, the ideal one is unclear.