MSCT诊断冠状动脉瘘合并冠状动脉起源变异一例

患者女,43岁。因子宫肌瘤、贫血入院。既往有先天性心脏病。体检:血压113/67 mmHg(1 mmHg=0.133 kPa),心率84次/min,心律齐,肺动脉瓣区闻及收缩期杂音。胸片、心电图正常。     

125I粒子支架植入治疗结肠癌复发患者一例

患者男,76岁,腹痛、腹胀3d入院。入院时体检:慢性消耗病容,神清合作,体温36.3℃,呼吸20次/min,心率101次/min,血压101/87 mmHg(1 mmHg=0.133 kPa)。     

左、右冠状动脉-肺动脉瘘二例

病例资料 病例1,女,61岁。因反复头晕、头痛、气短4年,血压升高3天入院。否认高血压、糖尿病及其他心脑血管病史。查体：体温36．8℃,脉搏55次／min,血压152／100mmHg,唇无紫绀,颈静脉无怒张,双肺无异常,心界无扩大．     

右冠状动脉开口于左冠状动脉窦内1例

病人,男,61岁.发作性心前区疼痛5 d,加重1 d.查体:脉搏83次/min,血压110/70 mmHg(1 mmHg=0.133kPa),心界无扩大,心率83次/min,律齐,心音弱,心脏各瓣膜听诊区无杂音.     

老年冠状动脉-肺动脉瘘致心功能不全1例

病例男,67岁,因反复左胸部刺痛2年,再发1个月入院。胸痛为左侧胸部及腋下刺痛,持续数秒钟,自行缓解。诱发因素不明,能耐受运动。有吸烟史20年,5～20支/d。无高血压、糖尿病、其他心脑血管病史。入院体检:血压130/80mmHg,双肺呼吸音清,心界不大,心率60次/min,律齐,各瓣膜听诊区未闻及杂音,双下肢无水肿。入院心电图:窦缓,电     

冠状动脉瘘似急性心肌梗死发作1例

患者,男,53岁。因突发胸痛1·5h入院,患者于入院前1·5h少量饮酒后,突感压榨样胸痛,有窒息感,伴大汗,疼痛呈持续性,向左肩及后背放射,当时神志恍惚,感头晕、恶心未呕吐,含服硝酸甘油后不缓解急诊入院。既往体健。查体:体温35·7℃,脉搏60次/min,呼吸18次/min,血压92/60mmHg。神志清,唇轻度紫绀,心率60次/min,律齐,心音弱,各瓣膜区未闻及杂音,两肺呼吸音清晰。心电图:窦律,Ⅱ、Ⅲa、vF ST段弓背向上抬高0·2mv,考虑冠心病,急性下壁心肌梗死,即刻静脉滴注尿激酶150万U,同时给予抗血小板凝聚、扩容等对症治疗后90min,胸痛逐渐缓解,血压升至11…     

苦碟子致血压升高1例

<正>病人,男,50岁。泛发性红斑鳞屑疹伴瘙痒10年,加重1个月。有原发性高血压病史4年,自行服药尼群地平10 mg 2次/d,卡托普利片25 mg 2次/d,血压控制良好。入院查体:T36.3℃,P 80次/min,R 20次/min,BP 113/83mmHg(1 mmHg=0.133 kPa)。入院当日依次给予:(1)苦     

主动脉内球囊反搏抢救急性广泛前壁心肌梗死合并心源性休克成功1例

1　临床资料　患者 ,男 5 4岁 ,因“反复活动后心慌、心前区闷痛 5d”入院。既往有“高血压病”2年 ,坚持服用“寿比山”血压控制良好。入院时体查 :体温 36 .8,脉搏 88次 /min ,血压 :130 / 85mmHg。急性痛苦面容 ,颈静脉无充盈 ,双肺呼吸音清晰 ,心界无扩大 ,心率 88次 /min     

心脏外伤急诊非体外循环冠状动脉搭桥一例

患者　女 ,39岁。心前区刀刺伤后胸痛、胸闷、心悸、气促 ,急送入院。入院时血压为 70 /5 0mmHg ( 1mmHg =0 .1 33kPa) ,心率为 1 30次 /min ,呼吸浅快 ,约 30次 /min ,脉搏细速。患者意识清楚 ,面色苍白 ,心前区第 4,5肋间见一长 3.5cm伤口。心电图 :窦性心动过速 ,ST段抬高。全胸正侧位片 :左侧胸腔积液 ,心影略增大。心脏彩超 :心包积液。入院诊断 :左侧胸外伤 ,左侧血气胸 ,急性心脏压塞可能。紧急气管内插管 ,全身麻醉下行开胸探查 ,择左后外侧切口。术中见左胸腔内约 1 0 0 0～1 5 0 0ml不凝鲜血 ,左肺舌叶见长 2cm裂口 ,心包呈球形…     

介入治疗起源于左冠窦的右冠状动脉急性闭塞一例

患者男,58岁.突发性胸骨后疼痛2 h入院.患者入院前2 h游泳后突然出现胸骨后疼痛,有濒死感,伴大汗,急来我院查心电图示Ⅱ、Ⅲ、aVF导联ST段抬高0.25～0.4 mV,诊断"急性下壁心肌梗死",静脉滴注硝酸甘油无效.患者平素有高胆固醇血症;无高血压、糖尿病病史.查体:脉搏66次/min,血压90/60 mmHg,唇略紫绀,颈静脉无充盈,双肺呼吸音清,未闻及明显干湿性啰音,心率66次/min,律齐,心音低钝,各瓣膜听诊未闻及杂音.     

Assessment of the severity of coronary artery stenosis by the ratio of the regional washout rate determined by adenosine triphosphate stress Tl-201 SPECT

BACKGROUND: Adenosine triphosphate stress thallium-201 single-photon emission computed tomography (ATP SPECT) is useful for diagnosis of coronary artery disease, but its usefulness for evaluating the severity of coronary artery stenosis has not been established. METHODS AND RESULTS: We performed region-of-interest analysis of short-axis images obtained by ATP SPECT in 31 patients with single-vessel disease (>50% stenosis of the luminal diameter). We selected the lowest and highest washout rates (WR) among the anterior, lateral, and inferior WRs and calculated the ratio of the lowest WR to the highest WR (WR ratio = 0.925+/-0.027 in 14 control subjects). ATP SPECT showed positive results in 29 (94%) of 31 patients. The severity of coronary artery stenosis was inversely correlated with the WR ratio (r = -0.703, P < .0001). The sensitivity and specificity of a WR ratio < or = 0.660 for the diagnosis of severe coronary stenosis (> or =80% stenosis) were 83% and 80%, respectively. CONCLUSIONS: Results suggest that ATP SPECT may be useful for assessment of the severity of coronary artery stenosis in patients with single-vessel disease.     

心电图诊断冠心病再评价

目的：通过冠状动脉造影证实心电图在诊断冠心病中的价值。方法：根据冠状动脉的造影结果，将100例患者分为冠心病组和非冠心病组，比较两组静息心电图和症状发作时心电图，了解心电图诊断冠心病的价值。结果：100例冠心病患者中54例(54％)诊断冠心病，其中静息心电图正常者26例(48％)，ST-T改变者11例(20％)，心律失常18例(33％)。而46例(46％)非冠心病患者，20例(43％)静息心电图正常，ST-T改变者8例(17％)，心律失常15例(32％)。在患者症状发作时，冠心病组动态ST-T改变者40例(74％)，而非冠心病组仅5例(10％)。结论：静息心电图在诊断冠心病中局限性很大，而症状相关性的动态ST-T改变在诊断冠心病中有较高价值。     

Infected (“Mycotic”) coronary artery aneurysm: Systematic review

BackgroundInfected coronary artery aneurysms (ICAA) represent a rare but potentially fatal complication of pre-existent atherosclerotic or non-atherosclerotic coronary artery disease, percutaneous coronary artery intervention, endocarditis or extracardiac infection.MethodsA retrospective analysis of four cases in addition to 51 infected coronary artery aneurysms from the literature, for a total of 55 ICAA was performed. Clinical and morphological information including age, sex, clinical presentation, microbial cultures, size, location and associated abnormalities as well as patient outcome was reviewed.Results83% of affected patients were adult males, with an average age of 55.24 years. The right coronary artery was the most commonly affected vessel (40%). In nearly 80% of the time, the responsible organism was either Staphylococcus aureus (53.3%), or Streptococcus (20%) infection. ICAA are typically large, on average 3.4 cm in diameter and can measure up to 9 cm. On contrast enhanced CT, imaging features include lobulated contour or saccular shape (54.2%) with thick wall or mural thrombus (87.5%). Associated abnormal appearance of the pericardium with either pericardial fluid, thickening or loculation is common (79.2%).ConclusionICAA are typically large, and characterized by a thick wall with a lobulated or saccular shape. Association with mediastinal, chest wall or pericardial abnormalities are common. This combination of findings, in the setting of fever, known infection, or recent coronary intervention should raise concern for ICAA.     

256层 CT 冠状动脉成像对冠状动脉桥血管的诊断价值

目的：探讨256层CT冠状动脉成像对冠状动脉搭桥术后桥血管的诊断价值。方法收集冠状动脉搭桥术后行256层CT 冠状动脉成像检查29例,回顾性分析256层 CT 冠状动脉成像桥血管的情况。结果29例搭桥血管共77支,搭桥血管1支6例,2支6例,3支10例,4支6例,5支1例,平均2.75支。59支(76.62%)桥血管通畅,17支(22.08%)桥血管管腔狭窄,1支(1.30%)桥血管闭塞。内乳动脉桥6支,大隐静脉桥71支;6支内乳动脉桥中,5支(83.33%)桥血管通畅,1支(16.67%)桥血管管腔狭窄;71支大隐静脉桥中,54支(76.06%)桥血管通畅,16支(22.54%)管腔狭窄,1支(1.40%)管腔闭塞。大隐静脉与内乳动脉桥血管狭窄、闭塞的发生率差异没有显著意义(P >0.05)。结论256层 CT 冠状动脉成像对冠状动脉搭桥术后桥血管的评价有较高的诊断价值,是一种简便、快速、无创、准确、安全的检查方法。     

经桡动脉途径无保护冠状动脉左主干分叉病变介入治疗

 目的 探讨经桡动脉途径PCI在无保护左主干分叉病变中治疗的可行性和疗效.方法 回顾性分析我院无保护左主干分叉病变择期行PCI的患者22例,21例置入药物洗脱支架,单支架置入7例,双支架置入14例,14例置入双支架的患者均成功进行对吻球囊扩张,1例系支架术后再狭窄,单纯行切割球囊成形术.术后每15 d或1个月门诊复查1次,3～9个月行冠状动脉造影复查.结果 22例PCI均取得成功,术后达TIMI 3级血流,住院期间主要不良心脏事件1例(4.55%),冠状动脉造影复查显示支架内再狭窄2例(10.53%),1例再次行PCI术.术后平均随访(16.86±6.90)个月,随访期内死亡1例.结论 经桡动脉径路无保护左主干分叉病变PCI即刻成功率高,有较好的近、中期疗效.     

非体外循环心脏跳动下冠状动脉旁路移植术582例

目的总结582例非体外循环辅助下冠状动脉旁路移植术(OPCAB)的手术技巧及术后处理的临床经验,并对其疗效及治疗经验进行初步探讨。方法回顾1998年10月~2005年4月共完成OPCAB582例,男506例,女76例,年龄35~86岁,其中不稳定型心绞痛558例,术前合并其他疾病480例。结果搭桥为2·6±1·3支/例,搭桥术后辅助呼吸时间为3·2±1·2h,术后住院为7±1·6天,心绞痛症状均消失。死亡2例,再次开胸止血1例,其余患者术后无纵隔感染和出血等并发症,均痊愈出院。近、中期随访临床效果满意。结论OPCAB由于避免了体外循环,减少了手术创伤和全身炎症反应,缩短了术后恢复时间,术后早期并发症发生率和死亡率低,对高危患者具明显优势。     

Anomalous intracavitary right coronary artery shown by cardiac CT: A potential hazard to be aware of before various interventions

Intracavitary right coronary arteries (RCAs) are uncommon (incidence of 0.09%-0.1%), having previously been reported nearly exclusively in autopsy series. However, more recently this entity has been detected prospectively by noninvasive cardiac computed tomography. Because many interventional procedures, including pacemaker placement and atrial flutter ablation, may be influenced by the presence of an intracavitary RCA, this entity is important to recognize. We report two cases of intracavitary right coronary artery discovered prospectively by cardiac computed tomography. In one of these cases, interventional management was altered based on our findings.     

桡动脉与股动脉行冠脉介入诊疗术的不良反应与并发症比较

目的对比经桡动脉与经股动脉行冠脉介入诊疗患者术后不良反应与并发症发生情况。方法将504例次行冠脉介入诊疗的患者分为A组(经桡动脉组)270例次、B组(经股动脉组)234例次,并观察、记录、对照二者的不良反应、并发症发生情况。结果 A组患者穿刺侧肢体疼痛、烦躁失眠、腰背疼痛、排尿困难或尿潴留、局部皮肤损伤等发生率明显低于B组(P<0.05或0.01),而动脉痉挛或畸形需更换入路或放弃的情况明显高于B组(P<0.05或0.01);手术并发症,A组患者拔管迷走神经反射、出血、血肿等情况的发生率明显低于B组(P<0.05或0.01),而动脉瘤、动脉闭塞、骨筋膜室综合征的发生率两组比较无统计学差异(P>0.05)。结论经桡动脉途径创伤小、并发症及不良反应少、卧床时间短、术后处理相对方便、安全,给患者带来的心理压力小,术后体位舒适,患者容易接受。