成年人瓣膜病合并冠心病的伴发情况分析

为了评估成年人瓣膜病变患者的冠心病伴发率。我们对本院自１９８８年６月至１９９５年１２月４０岁以上５５０例瓣膜病者的冠状动脉造影进行回顾性研究。男３４３例，女２０７例。年龄４０￣７２岁，平均５４．３岁。二尖瓣、主动脉瓣和联合瓣膜损害分别为２０５例。１０７例，２３８例。１５６例心电图呈ＳＴ－Ｔ改变，１１６例有心绞痛症状。结果：５５０例中７６例冠状动状有单支或多支≥５０％的狭窄病变，占１３．８％，就年龄     

169例心脏瓣膜病冠状动脉造影分析

心脏瓣膜病患者瓣膜置换术前了解冠状动脉形态和变异，对手术时是否同时作搭桥术及术后处理有重要意义，国内对此报道极少。我们对１６９例心脏瓣膜病者术前临床资料和冠状动脉造影结果进行综合分析对比，结果表明：１４．８％的心脏瓣膜病伴发冠心病，其中无症状者占８０％。由于瓣膜病患者常有心电图ＳＴ－Ｔ的非特异性改变（本组达７８．４％），使临床常用的无创性检查不能对合并冠心病作出肯定诊断，必须作冠状动脉造影才能确诊。本研究表明，年龄大于５０岁者，心瓣膜置换术前应常规行冠状动脉造影检查，以减少手术并发症及病死率。     

心瓣膜病患者颈动脉狭窄的发病情况评估

目的:评估瓣膜病患者颈动脉狭窄的发病率,并对其相关危险因素进行研究。方法:196例超声确诊欲行瓣膜置换术的患者,术前常规冠状动脉造影的同时行颈动脉血管造影。根据造影结果分成两组,单纯瓣膜病组147例(75%),瓣膜病伴发冠心病组49例(25%),分析颈动脉狭窄的发病率。同时将年龄、体质指数、高血压病史、吸烟史及相关生化危险因素作为独立危险因素行多因素逐步Logistic回归分析。结果:瓣膜病伴发颈动脉狭窄总发病率为13%,其中颈动脉狭窄≥70%发生率为7%。单纯瓣膜病组颈动脉狭窄发病率为6%,瓣膜病伴发冠心病组为34%,差异有统计学意义(P<0.01),多因素Logistic回归分析显示,年龄、冠心病史和高血压史与颈动脉狭窄密切相关(P<0.05)。结论:瓣膜病伴发冠心病患者的颈动脉狭窄发病率达34%,术前常规冠状动脉造影的同时,可行颈动脉造影以确诊。     

瓣膜病合并冠心病的外科治疗

目的 总结61例同期行心脏瓣膜手术和冠脉搭桥术(CABG)的临床经验.方法 2001年10月至2009年6月,共同期行心脏瓣膜手术及CABG 61例,其中二尖瓣成形7例、二尖瓣置换33例、主动脉瓣置换8例、双瓣置换9例、Bentall术3例、Wheat术1例,同期移植血管112支,平均1.90支.结果 术后早期死亡2例(3.3%,2/61),死因为低心排综合征.其余并发症包括出血、切口感染、肾功能不全,经相应处理痊愈.随访1～93个月,随访54例,症状和体征均明显改善.远期死亡1例(急性肺栓塞).结论 瓣膜病合并冠心病经过精心术前准备,术中充分再血管化,恰当的处理瓣膜,良好的心肌保护,外科治疗效果满意.     

Coronary artery stenosis in patients with valvular heart disease

144 patients with valvular heart disease (VHD) underwent selective coronary angiography. Significant coronary artery stenosis was found in 26% of the examined patients. Diagnostic accuracy of some clinical indexes was analysed in this group. Most useful in predicting the presence of significant coronary narrowing in patients with VHD were increased cholesterol level and the presence of arteriosclerosis in lower limbs. Patients over 40 years who have both these indicators should have coronary angiography performed prior to surgical treatment.     

Impact of coronary artery disease on valvular heart surgery

Patients who undergo coronary bypass grafting in association with aortic valve replacement currently have a low in-hospital mortality, but their late survival is inferior to that of patients without coronary disease who undergo isolated aortic valve replacement. Patients who receive porcine heterografts to replace the aortic valve have better late survival and event-free survival after aortic valve replacement combined with bypass grafting than those who received mechanical valves. The analyses of patients who combine coronary artery and mitral valve disease is difficult because of changing surgical practices and diagnostic techniques. Patients undergoing surgery for mitral valve replacement combined with bypass grafting have had higher in-hospital mortality and worse late survival than patients undergoing aortic valve replacement combined with bypass grafting. The increased use of techniques for reconstructing rather than replacing the mitral valve may help improve the long-term results for patients undergoing surgery for mitral valve dysfunction combined with coronary disease.     

Incidence and clinical symptomatology of coronary heart disease in acquired valvular defects

220 consecutive patients with acquired valvular defects were checked within the preoperative examination by means of heart catheter with regard to significant coronary stenoses. In these cases a relative frequency of typical and atypical angina pectoris troubles of 0.136 and 0.459, respectively, was the result. In contrast to this significant coronary stenoses could relatively infrequently made evident angiographically: 6/220 (= 0.027). In patients with valvular defects angina pectoris cannot be used as the leading symptom of an additionally existing coronary heart disease on account of bad sensitiveness.     

Prevalence of significant coronary heart disease in valvular heart disease in Indian patients

Records of 326 patients were analysed to determine the prevalence of coronary heart disease (CHD) in patients with valvular heart disease (VHD) and to identify the group in whom coronary arteriography is essential. Significant CHD (60% or more luminal narrowing) was found in 7 per cent of cases, and its prevalence was 3 per cent in mitral, 10 per cent in aortic, and 6 per cent in combined mitral and aortic valve disease. Angina was present in 14 per cent of patients with mitral, 39 per cent with aortic, and 21 per cent with combined mitral and aortic valve disease. Seventy-three per cent of patients with CHD had angina whereas only 19 per cent with angina had CHD. The prevalence of CHD was higher in patients above 50 years (13%) and in males (98%) as compared to those below 50 years (3%) and females (none). We conclude that the prevalence of CHD is low in our patients with VHD. Routine coronary arteriography is recommended only in males over the age of 50 years.     

Angina, coronary risk factors and coronary artery disease in patients with valvular disease. A prospective study

The relationship between coronary risk factors and coronaryartery disease in patients with valvular heart disease was studiedprospectively in 387 consecutive patients undergoing routinecoronary arteriography prior to valve replacement. Coronary artery disease was as common in patients with mitralvalve disease (31.9%) as in those with aortic valve disease(26.8%) Although it occurs more frequently in patients withangina (45.7%) significant coronary artery disease is foundin 19.2% (47 of 245) of those without angina (P<0.001), suggestingthat the presence of angina alone is an unreliable indicatorof significant coronary disease. The prevalence and severityof significant coronary artery disease increases progressivelyas the number of coronary risk factors also increase (P<0.001)but the prevalence is low (3%) in patients in whom both anginaand coronary risk factors are absent. These findings suggestthat preoperative coronary arteriography might be omitted inthis latter group of patients.     

Report: Association of coronary artery disease and valvular heart disease in chile

This study analyzes the prevalence of coronary artery disease (CAD) among patients with rheumatic valvular heart disease (VHD) in Chile. Coronary angiography was performed in all patients referred to cardiac catheterization with VHD who were over age 50 years and who had angina or ECG signs of ischemia. A total of 100 patients entered the study. Significant CAD (greater than 50% obstruction) was found in 14% of the cases: 7% in patients with mitral valve disease (MVD), 18% in aortic valve disease (AVD), and 21% in combined mitral and aortic valve disease (MAVD). Angina was present in 14% of the patients with MVD, 63% with AVD, and 53% with MAVD. Only 57% of patients with CAD had angina pectoris; 20% with angina had CAD. Hemodynamic parameters and left ventricular ejection fraction were not correlated with the presence or absence of CAD. We conclude that in patients with valvular heart disease, the incidence of CAD is lower in Chile than previously reported in the English literature. We confirmed the fact that angina is often not associated with CAD, and that CAD is often present in the absence of angina.     

Angina pectoris and coronary artery disease in patients with severe aortic valvular disease

We studied the clinical, hemodynamic, and angiographic findings of 90 consecutive patients with significant symptomatic aortic valve disease, 40 years of age or older, to evaluate the prevalence of angina pectoris in relation to coronary artery disease and the effect upon cardiac function.The prevalence of chest pain was 66% (typical angina, 39%; atypical chest pain, 27%), and the prevalence of coronary artery disease was 39%. The prevalence of coronary artery disease in patients with typical angina was 77%, in contrast to 25% in patients with atypical chest pain $\text{(}\text{P}\text{= 0.001)}$. Only two of the 35 patients (6%) with coronary artery disease were free of chest pain. Although the incidence of coronary artery disease in patients with aortic stenosis was slightly higher than in patients with aortic regurgitation or aortic stenosis-aortic regurgitation, it was not statistically significant.Patients with aortic regurgitation and coronary artery disease had significantly lower ejection fraction than patients with aortic stenosis and coronary artery disease. There were no significant differences between ejection fraction in patients without coronary artery disease in the different groups. Patients with aortic stenosis and coronary artery disease tend to have lower mean pressure gradients than those without coronary artery disease. Patients with coronary artery disease in aortic regurgitation and aortic stenosis-aortic regurgitation tend to have higher left ventricular end-diastolic pressure.This study indicates that although patients with aortic valve disease and typical angina are most likely to have associated coronary artery disease, it is not possible to predict this disorder with accuracy by means of clinical or hemodynamic findings.Since the presence or absence of coronary artery disease in patients undergoing aortic valve replacement has prognostic and therapeutic significance, we recommend that coronary arteriography be performed in all patients with significant aortic valve disease undergoing cardiac catheterization when they present with any form of chest pain, or in patients over the age of 40 years even if no chest pain is present. Coronary arteriography would also rule out anomalous aortic origin of the coronary arteries.     

冠心病合并肾动脉狭窄的发生率及危险因素

目的探讨冠心病合并肾动脉狭窄的发生率及危险因素。方法回顾性分析2003年5月至2004年8月期间造影证实冠心病同时行肾动脉造影患者的临床资料及影像学资料。结果350例冠心病中48例患者合并有肾动脉单侧或双侧显著性狭窄(直径狭窄≥50%),发生率为13.7%。多因素Logistic回归分析显示:年龄≥70岁、血肌酐≥120μmolL、高血压及冠状动脉多支病变是预测冠心病合并肾动脉狭窄的危险因素。结论冠心病患者合并肾动脉狭窄的发生率较高,对其行冠状动脉造影检查的同时应常规行肾动脉造影检查以检出合并的肾动脉狭窄。     

冠心病并存血糖异常患者冠状动脉病变特点的分析

目的探讨冠心病并存血糖异常患者冠状动脉病变的特点。方法对2006年1月至2006年6月在山西医科大学第一医院行冠状动脉造影术确诊为冠心病的136例患者进行回顾性分析,分为两组:血糖异常组64例,血糖正常组72例,对两组患者的临床特点和冠状动脉造影结果进行对比分析。结果两组资料在年龄、性别、吸烟史、体重指数、高密度脂蛋白胆固醇、心肌梗死发生率和冠状动脉病变的部位方面的比较均无显著差异(P>0.05)。血糖异常组高血压、胆固醇、甘油三酯、低密度脂蛋白胆固醇以及载脂蛋白B均高于血糖正常组(P<0.05);血糖异常组冠状动脉病变的狭窄程度重,中度、重度狭窄、多支病变和弥漫性病变发生率显著增高(P<0.05)。结论冠心病伴血糖异常的患者多同时伴有冠心病的其他危险因素,其冠状动脉病变复杂,病变程度严重,多支病变和弥漫性病变增多。     

Incidence of coronary artery disease in siblings of patients with premature coronary artery disease: 10 years of follow-up

Although family history of premature coronary artery disease (CAD) confers increased risk of CAD, the magnitude of this increase beyond that expected from the risk factors incorporated in the Framingham Risk Equation (FRE) remains unknown. We prospectively determined the accuracy of the FRE 10-year incident CAD events prediction in initially healthy siblings of patients with documented premature CAD. We recruited 784 siblings (30 to 59 years) of 449 patients hospitalized with CAD <60 years of age (1983 to 1995). We compared the estimated 10-year incidence of total CAD events by the gender-specific FREs at baseline, to the observed incidence at 10 years of follow-up. In men, the 10-year actual CAD event rate was 20%, only half of which was predicted by the FRE (12% vs 20%, p <0.001). In women, the observed CAD event rate was 7.1% (p <0.001 vs men), modestly but not significantly greater than the 6.3% predicted by the FRE (p = 0.34). Thus, there was a significant 66.6% excess risk in men, and a nonsignificant 12.7% excess risk in women beyond the risk predicted by the FRE for total CAD events. The FRE and its known classic risk factor profile failed to accurately predict total incident 10-year CAD events in individuals with a sibling history of premature CAD, most particularly in men. In conclusion, in families with a history of premature CAD, the excess risk observed cannot be attributed to traditional risk factors, suggesting a major role for as yet undetermined genetic and other susceptibility factors.