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1.
冠状静脉动脉化治疗弥漫性冠状动脉病变五例临床报告   总被引:2,自引:0,他引:2  
目的:探索不适合经皮冠状动脉介入治疗和冠状动脉旁路移植术的弥漫性冠状动脉病变病人经静脉血运重建的可行性.方法:5例具有弥漫性冠状动脉病变的病人,在体外循环或非体外循环下旁路移植到该冠状动脉的伴行静脉,并结扎该静脉的近端,凭借静脉的逆行灌注改善缺血区域的血供.结果:5例病人均存活,旁路流量为51~120(平均78.6)ml/min,术后心绞痛消失,部分病人核素复查显示静脉动脉化后的相关区域灌注改善.结论:冠状静脉动脉化用于治疗弥漫性冠状动脉病变的技术可行并有疗效.  相似文献   

2.
急性心肌梗死再灌注后心电图ST段抬高的意义   总被引:4,自引:0,他引:4  
目的:探讨急性心肌梗死(AMI)患者接受经皮冠状动脉腔内成形术(PTCA)治疗心电图ST段持续高与临床预后的关系。方法:AMI患者共30例,比较PTCA前及术后1h12导联心电图抬高ST的总和,按ST段下降幅度分为两组,A组:AT段下降≥50%,B组:ST段下降<50%。行小剂量多巴酚丁胺负荷超声心动图检查并随访复查超声心动图。结果:AMI发病早期基础状态和负荷状态及发病后第1、2、3个月左室射血分数(LVEF)A组均明显大于B组。多巴酚丁胺负荷状态下主动脉峰值血流加速度、每搏输出量及每搏指数A组明显大于B组。基于状态和负荷状态下总室壁运动积分指数(GWMSI)和梗死区室壁运动积分指数(IWMSI)A组均明显小于B组,AMI发病后1、2、3个月GWMSI A组均明显小于B组。发病第1、2个月IWMSI两组间差异无统计学意义。发病第3个月IWMSI A组明显小于B组。AMI直接PTCA后心电图ST段持续抬高的患者左室收缩功能及收缩储备功能以及梗死区室壁运动的恢复明显低于ST段迅速下降者。  相似文献   

3.
心肌致密化不全的超声心动图诊断   总被引:3,自引:0,他引:3  
1心肌致密化不全(noncompaction of the ven-tricular myocardium,NVM)又称为“海绵状心肌”、“持续性心肌窦状隙”,为临床上少见的先天性疾病。随着检查手段和认识的提高,其检出率有所提高。该病有家族发病倾向但非为单一遗传背景,可单独发病或同时并发其他先天性心脏畸形。1  相似文献   

4.
11例成人心肌致密化不全临床分析   总被引:12,自引:1,他引:11  
目的:探讨成人心肌致密化不全(NVM)患者的临床特点。方法:回顾性分析 11 例成人 NVM患者的临床表现及超声心动图、X线胸片、心电图等辅助检查结果。结果:多数患者NVM以左心功能不全就诊,其次为室性心律失常。结论:NVM临床病程迁延,临床表现各异,易造成误诊和漏诊,超声是重要的诊断和筛查手段。  相似文献   

5.
目的 :分析永存动脉干 ( PTA)结构、血流动力学特征 ,并探讨切面的选择。方法 :应用彩色多普勒超声仪检测11例疑诊为 PTA患者的二维超声心动图 ( 2 DE)和彩色多普勒血流图 ( CDFI)。所有患者均使用剑突下、胸骨旁和胸骨上窝多部位和多切面检查心内结构。结果 :10例确诊为 PTA,1例诊断为肺动脉闭锁 ,心血管造影证实 11例均为 PTA。PTA 型 2例 , 型 1例 , 型 4例 , 型 4例。PTA起源左右心室之间 5例 ;主要起源于右心室 6例 ,骑跨率≥ 60 %。PTA双叶和四叶各 1例 ,三叶 9例。结论 :2 DE和 CDFI可用于识别 PTA病理解剖结构 ,血流动力学特征 ,且诊断符合率高 ( 91% )  相似文献   

6.
目的探讨孤立性心肌致密化不全(NVM)患者的临床特点。方法回顾性分析11例孤立性NVM患者的临床表现及超声心动图、X线胸片、心电图等辅助检查等资料。结果多数患者NVM以左心功能不全就诊,其次为室性心律失常。结论 NVM临床病程迁延,临床表现各异,易造成误诊和漏诊,超声是重要的诊断和筛查手段。  相似文献   

7.
冠状微循环障碍与心肌再灌注损伤   总被引:10,自引:0,他引:10  
冠状微循环障碍是心肌再灌注损伤时重要的病理生理改变之一。在其发生机制上,内皮细胞功能异常(尤其是粘附分子的作用)以及微血管舒缩功能障碍成为近年来研究的热点。由此也产生了相应的干预措施。  相似文献   

8.
目的 :制备可经静脉注射产生心肌对比增强效果的声学对比造影剂 ,观察其心肌显影效果。方法 :1按不同比例将 5 0 g· L- 1 葡萄糖或 9g· L- 1 Na Cl,C3 F8气体与人血白蛋白混合后进行超声振荡。 Coulter’ s计数器对造影剂进行质量分析。 2经犬股静脉注射自制对比造影剂 0 .2 ml,经胸壁扫查犬左室乳头肌水平短轴切面。结果 :1造影剂微泡液的相对浓度为 4 .2 3 9× 10 9/m l,微泡平均直径 3 .789μm,小于 9.89μm微泡占 99.5 %。 2经静脉注射后 ,均产生不同程度的心肌对比增强效果 ,心肌显影持续时间 1~ 3 min。注射前后犬血流动力学无显著性改变。结论 :自制经静脉注射对比造影剂符合心肌声学造影的要求 ;初步动物实验表明经静脉注射可产生肉眼可辨的心肌显影 ;反复注射无明显血流动力学改变  相似文献   

9.
目的 :探讨心电图ST T改变对估测高血压心肌微血管病变的价值。方法 :应用心肌对比超声心动图 (MCE) ,静注微泡造影剂 (全氟显 )后 ,采用间断谐波成像技术测量静息时和注射双嘧达莫后心肌的A、β和A·β值 ,并计算出A、β比值和冠状动脉微血管的血流储备 (CMVFR)。 结果 :与对照组相比 ,原发性高血压 (EH)伴ST T改变和无ST T改变患者静息时的A、β和A·β值均增高 ,尤以伴ST T改变者增高更明显 ;而应用双嘧达莫后它们增加的幅度明显减少 ,A、β比值以及CMVFR显著降低 ,其中ST T改变患者的 β值和CMVFR降低更明显 ;随着高血压病情的加重 ,A和A·β值增高 ,A值和CMVFR下降 ,A和A·β值与SBP、DBP显著正相关 (P <0 .0 1) ,CMVFR与DBP显著负相关 (P <0 .0 1) ;ST段改变与A比值 (r =0 .5 2 9,P <0 .0 1)和CMVFR(r =0 .4 11,P <0 .0 5 )显著相关。结论 :EH患者 ,尤其是伴ST T改变患者的静息心肌微循环血流量增加、心肌微血管储备功能和非内皮依赖性的血管扩张能力明显受损、心肌毛细血管密度明显减少 ,并且随着疾病的进展而加重 ;EH患者如果出现心电图ST T改变时应考虑存在心肌微血管病变的可能性 ;MCE对诊断高血压微血管疾病有着良好的应用前景  相似文献   

10.
心肌致密化不全的临床特征及文献复习   总被引:5,自引:2,他引:3  
目的:增加对心肌致密化不全临床特征的认识。方法:通过复习文献对6例心肌致密化不全患者的心电图、超声心动图及病理解剖特征进行了分析。结果:6例患者的主要表现均为进行性心功能不全、左房左室扩大,病变区域室壁表现为外层中低回声的致密心肌明显变薄,心脏大体切片显示从心底至心尖致密心肌逐渐变薄,心尖最薄处几乎无致密心肌组织。结论:心肌致密化不全的诊断多以超声心动图为依据。  相似文献   

11.
Our understanding of coronary syndromes has evolved in the last two decades out of the obstructive atherosclerosis of epicardial coronary arteries paradigm to include anatomo-functional abnormalities of coronary microcirculation. No current diagnostic technique allows direct visualization of coronary microcirculation, but functional assessments of this circulation are possible. This represents a challenge in cardiology. Myocardial contrast echocardiography (MCE) was a breakthrough in echocardiography several years ago that claimed the capability to detect myocardial perfusion abnormalities and quantify coronary blood flow. Research demonstrated that the integration of quantitative MCE and fractional flow reserve improved the definition of ischemic burden and the relative contribution of collaterals in non-critical coronary stenosis. MCE identified no-reflow and low-flow within and around myocardial infarction, respectively, and predicted the potential functional recovery of stunned myocardium using appropriate interventions. MCE exhibited diagnostic performances that were comparable to positron emission tomography in microvascular reserve and microvascular dysfunction in angina patients. Overall, MCE improved echocardiographic evaluations of ischemic heart disease in daily clinical practice, but the approval of regulatory authorities is lacking.  相似文献   

12.
超声心动图负荷试验评价冠状动脉再通治疗后心肌缺血   总被引:1,自引:0,他引:1  
为评价冠心病患者冠状动脉(冠脉)再通治疗后的心肌缺血,对57例冠脉扩张或冠脉搭桥术后有胸痛等症状的病人进行超声心动图多巴酚丁胺或运动负荷试验(DSE/TMX)。结果:DSE/TMX阳性提示心肌缺血者26例,占45.6%,均无严重并发症发生。10例再行冠脉造影,6例DSE/TMX阳性者中,5例相应血管严重狭窄,1例相应血管轻微病变,4例DSE/TMX阴性者中,2例冠脉造影示相应血管亦无严重狭窄。表明:DSE/TMX可用于筛选划分需再次行血管再通治疗及需加强扩张冠脉药物治疗的病人,也可用于筛选冠脉再通治疗后心肌缺血的低危病人群。DSE/TMX是安全有效的心肌缺血评价手段。  相似文献   

13.
目的探讨心肌声学造影(MCE)评估缺血心肌血运重建后心肌灌注的价值。方法 36例缺血性心肌病患者分别予以冠状动脉支架置入术或冠状动脉旁路移植术进行血运重建,在术前、术后早期(〈1个月)、及术后晚期(6~12)个月分别行实时MCE检查,根据造影剂的充盈程度进行评分。将其结果与相应阶段造影(CAG)和(或)冠脉增强CT成像(CTA)结果进行对照分析。结果按16段心肌节段法进行分段分析测量。36例患者576个节段中,运动异常节段247个,MCE结果与治疗前冠脉造影吻合率为89.89%。冠脉血管再通术后早期共有172个节段有改善,与冠状动脉支架置入术或冠状动脉旁路移植术靶血管供血支配区吻合率为78.00%。术后晚期,MCE与冠脉影像结果吻合率为80.56%。结论实时MCE可随访观察冠状动脉再通血运重建缺血心肌血流灌注改善的情况,可尝试用于冠心病血管重建术后的临床随访。  相似文献   

14.
目的应用心肌声学造影(MCE)评估急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后冠状动脉微循环障碍(CMD)的发生情况,并探讨其对心功能的影响。方法入选2016年6月至2021年5月北京大学人民医院因STEMI住院行PCI,并于住院期间完成MCE的患者109例。根据MCE检查分为CMD组及微循环功能正常组。分析两组患者的一般临床资料、STEMI相关临床情况、冠状动脉造影及血运重建情况以及MCE资料。结果109例STEMI患者中CMD发生率为66.1%。CMD组患者与正常组相比C反应蛋白水平更高[10.0(1.3,46.2)mg/L比1.7(0.5,15.5)mg/L,P=0.029],脑钠肽水平更高[333(100,685)pg/ml比125(39,348)pg/ml,P=0.016],左心室射血分数(LVEF)更低[51.0%(43.1%,58.9%)比58.9%(51.5%,63.8%),P=0.002],左心室整体长轴应变更差[–10.8%(–8.1%,–13.6%)比–13.3%(–10.5%,–16.7%),P=0.006],节段性室壁运动异常(RWMA)比例更高(95.8%比78.4%,P=0.004),室壁运动评分指数(WMSI)更差[1.53(1.37,1.88)比1.29(1.09,1.47),P<0.001],室壁瘤发生率更高(19.4%比0,P=0.004)。且校正罪犯血管的影响后,两组患者LVEF、RWMA比例及WMSI依旧差异有统计学意义(均P<0.05)。结论与微循环功能正常组相比,STEMI后出现CMD的患者具有更高的炎性水平,室壁运动及心功能相对更差,提示不良预后。  相似文献   

15.
A coronary artery-left ventricular fistula (CAF) is an extremelyrare anatomical abnormality in which blood drains directly froma coronary artery into the left ventricle. CAF may cause myocardialischaemia and angina. Myocardial contrast echocardiography (MCE)is a non-invasive technique which assesses myocardial perfusion.We describe a patient with CAF in whom transmural myocardialischaemia was demonstrated using MCE.  相似文献   

16.
The availability of myocardial contrast echocardiography (MCE) has potential for several applications in coronary diseases. Experimental studies have demonstrated a good correlation between measurements of myocardial blood flow and regional contrast intensity, and therefore capabilities of MCE in detecting myocardial ischemia during stress. Clinical studies must then demonstrate the value of such approaches in comparison with existing techniques such as stress echo and radionuclide imaging.  相似文献   

17.
Summary In addition to coronary arteriography, myocardial contrast echocardiography (MCE) was performed in 25 patients with coronary artery lesions due to Kawasaki disease, in order to investigate its validity in the evaluation of these lesions and its safety in children. The patients' ages ranged from 1.0 to 15.9 years (mean, 8.6 years). Their coronary artery lesions included occlusion in 9 branches (9 patients), segmental stenosis in 9 (8 patients), localized stenosis in 16 (12 patients), and dilated lesions without coexistent stenotic lesions in 5 patients. Seven patients had coronary artery bypass grafts. Myocardial perfusion patterns of the stenotic lesions and coronary artery bypass grafts could be clearly demonstrated by MCE. For the assessment of safety, electrocardiograms obtained at the time of MCE and coronary arteriography in 14 patients showed no significant difference in the findings between MCE and coronary arteriography. Serum glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, lactic dehydrogenase, and creatine phosphokinase levels were measured before and 1 day after the procedure in 14 patients who underwent MCE and coronary arteriography, and in a group of 14 patients who underwent coronary arteriography alone. No significant difference was noted between the values of the two groups. These results suggested that MCE can be utilized in the assessment of coronary artery lesions due to Kawasaki disease, and confirmed the safety of the procedure even in young children.  相似文献   

18.
AIMS: The study was set up to evaluate the functional role of post-infarctpreserved microvascular integrity. Low dose dobutamine echocardiographyand myocardial contrast echocardiography were used to studypatients before hospital discharge who had suffered a recentmyocardial infarction and had a patent infarct-related artery(TIMI flow grade 3). METHOD: In the dysfunctioning infarct area, the wall motion score indexwas calculated at baseline, during the dobutamine infusion andat the 3 month follow-up echocardiogram; contrast echocardiographywas performed at the time of coronary angiography, before hospitaldischarge. RESULTS: In patients with more than 50% of the dysfunctioning infarctarea opacified at contrast echocardiography (group A), regionalwall motion score index decreased, compared to baseline, duringthe dobutamine infusion (1·97 ± 0·78 vs2·5 ± 0·35 at baseline; P<0·001)and at follow-up echocardiography (1·83 ± 0·63vs 2·5 ± 0·35 at baseline; P<0·001).In patients with less extensive microvascular integrity as revealedby contrast echocardiography (group B), regional wall motionscore index did not decrease from baseline during either thedobutamine infusion (2·73 ± 0·21 vs 2·81± 0·20 at baseline; P=ns) or at follow-up (2·81± 0·20 vs 2·81 ± 0·20 atbaseline; P=ns). CONCLUSION: In patients with post-infarct dysfunctioning myocardium buta patent infarct-related artery, microvascular integrity, asassessed by myocardial contrast echocardiography, is an indicatorof myocardial viability in terms of preserved contractile reserve,as demonstrated by dobutamine infusion and functional recoveryat follow-up.  相似文献   

19.
Summary Using myocardial contrast echocardiography (MCE), coronary arteriography, and thallium-201 myocardial imaging (TMI), we examined the characteristics and the role of collateral vessels in 35 patients with coronary artery lesions after Kawasaki disease. The male/female ratio was 25∶10. The patients' ages at examination ranged from 1.0 to 20.3 years (mean, 10.8 years). The age at onset of Kawasaki disease ranged from 0.3 to 11.6 years (mean, 2.6 years). The coronary artery lesions were: dilated lesions without coexistent stenotic lesions in 5 patients (14%), localized stenosis with less than 50% narrowing in 5 patients (14%), localized stenosis with 50% or more narrowing in 4 patients (11%), and obstructive lesions, such as occlusion and/or segmental stenosis, in 21 patients (60%). In the group with no stenotic lesions and the group with less than 50% localized stenosis, the perfusion area of the right coronary artery was 32.6±8.4% and that of the left coronary artery was 76.3±7.9%. The total perfusion area of the right and the left coronary arteries was 108.9±2.6%, which value was inversely correlated with age at examination (r=0.716,P=0.020). In the group with more than 50% localized stenosis, an increase in overlap areas detected by MCE, where a perfusion defect was seen on TMI, was not found, except in 1 patient with 99% stenosis. In the patients with obstructive lesions, development of collateral channels was better in the perfusion area of the occluded right coronary artery than in that of the occluded left coronary artery, and well developed collateral channels were significantly correlated with good wall motion. We conclude that overlapping perfusion occurs in younger rather than in older children without stenotic coronary systems and this may contribute to the good development of collateral circulation in infants and young children with coronary artery lesions after Kawasaki disease.  相似文献   

20.
Summary Previous studies have demonstrated pronounced ischemic zone myocardial concentrations of metoprolol following coronary venous retroinfusion in pigs with coronary artery ligation. The effect of coronary venous retroinfusion of metoprolol on myocardial infarct size was studied in 16 pentobarbital-anesthetized open-chest pigs undergoing 60-minute occlusion of the left anterior descending coronary artery followed by 3 hours of reperfusion. Pigs in the experimental group (n=8) were given 0.4 mg/kg (1.0 mg/ml) of metoprolol via the anterior interventricular vein over a period of 5 minutes, beginning immediately after coronary occlusion followed by 0.2 mg/kg/hr intravenously. Control pigs (n=8) received the same volume of saline as the treated group. The risk area and the necrotic area were assessed by monastral blue dye and triphenyl tetrazolium chloride staining, respectively. Metoprolol did not influence hemodynamics. Plasma concentrations of metoprolol were within therapeutic levels. The administration of the beta-blocker resulted in a trend toward reduced norepinephrine concentrations, both in the aorta and coronary vein after coronary occlusion, but it did not prevent norepinephrine overflow following reperfusion. Infarct size expressed as a percentage of the risk area was 77±11% in the control group and 75±12% (mean ± SD; NS) in the treated group. Thus, metoprolol retroinfusion did not reduce infarct size and did not prevent catecholamine overflow after reperfusion. It is concluded that the beneficial effects of metoprolol in acute infarction are probably unrelated to local beta-adrenergic blockade, at least in the pig, an animal with a paucity of coronary collateral blood flow.  相似文献   

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