Usefulness of dobutamine stress myocardial contrast echocardiography for assessing coronary artery disease

Background Quantitatively assessing myocardial perfusion and its reserve is of great importance for the diagnosis and stratification of patients with coronary artery disease (CAD), and represents an important goal of myocardial contrast echocardiography. In this study we sought to test the usefulness of low dose dobutamine stress real-time myocardial contrast echocardiography (RT-MCE) in the assessment of CAD, and to explore the relationship between perfusion reserve and contractile reserve.Methods Twenty-six patients with suspected or clinical diagnosed CAD were enrolled and underwent RT-MCE at baseline and under low dose dobutamine stress, and subsequent coronary angiography. RT-MCE images were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion and its reserve. Results At baseline, significant differences in beta (0.28±0.12, 0.25±0.09, 0.22±0.06, 0.20±0.07 respectively, P＜0.01) and A×beta (1.37±0.46, 1.28±0.47, 1.13±0.37, 0.91±0.32, respectively, P＜0.01) were observed among four segment groups with graded coronary artery stenosis severity (normal; 30%-69% stenosis; 70%-90% stenosis; and beyond 90% stenosis), but not observed in parameter A. When under stress, significant differences in A (5.73±1.28, 5.63±1.01, 4.96±0.81, 4.57±0.62, respectively, P＜0.01), beta (0.67±0.17, 0.55±0.19, 0.32±0.13, 0.25±0.08, respectively, P＜0.01) and A×beta (3.81±1.20, 3.11±1.17, 1.59±0.82, 1.12±0.37, respectively, P＜0.01) were observed among the formerly mentioned groups. Graded decreases in A reserve (1.20±0.53, 1.11±0.16, 0.98±0.12, 0.99±0.13, respectively, P＜0.01), beta reserve (2.65±1.07, 2.32±0.82, 1.44±0.40, 1.29±0.34,respectively, P＜0.01) and A×beta reserve (3.05±1.63, 2.59±1.01, 1.42±0.44, 1.27±0.34, respectively, P＜0.01) could also be observed with increasing coronary stenosis severity. In five segments groups scored by WMS (1-5), concordance between contractile function and myocardial perfusion could be found both at rest (beta: 0.28±0.11, 0.22±0.08, 0.21±0.05, 0.17±0.05, 0.19±0.06, respectively, P＜0.01; A×beta: 1.29±0.48, 0.98±0.45, 0.94±0.29, 0.76±0.30, 0.92±0.32, respectively, P＜0.01) and under stress (beta: 0.59±0.20, 0.35±0.15, 0.27±0.08, 0.17±0.05, 0.20±0.05, respectively, P＜0.01; A×beta: 3.07±1.38, 1.62±0.82, 1.28±0.40, 0.78±0.24, 0.93±0.22, respectively, P＜0.01). This concordance is also valid in terms of the reserves, and the MCE parameters in segments with ameliorated contractile function are significantly higher than in those without. Conclusions Quantitative RT-MCE in conjunction with dobutamine stress shows promise in identifying and stratifying CAD and in exploring the perfusion-contractile correlation. Chin Med J 2005; 118(21):1766-1772     

Value of Quantitative Tissue Velocity Imaging in the Detection of Regional Myocardial Function in Dogs with Acute Subendocardial Ischemia

This study evaluated the application of quantitative tissue velocity imaging （QTVI） in assessing regional myocardial systolic and diastolic functions in dogs with acute subendocardial ischemia. Animal models of subendocardial ischemia were established by injecting microspheres （about 300 μm in diameter） into the proximal end of left circumflex coronary artery in 11 hybrid dogs through cannulation. Before and after embolization, two-dimensional echocardiography, QTVI and real-time myocardial contrast echocardiography （RT-MCE） via intravenous infusion of self-made microbubbles,were performed, respectively. The systolic segmental wall thickening and subendocardial myocardial longitudinal velocities of risk segments before and after embolization were compared by using paired t analysis. The regional myocardial video intensity versus contrast time could be fitted to an exponential function： y=A·（1-exp-β·t）, in which the product of A and β provides a measure of myocardial blood flow. RT-MCE showed that subendocardial normalized A·β was decreased markedly from 0.99±0.19 to 0.35±0.11 （P〈0.05） in 28 left ventricular （LV） myocardial segments after embolization, including 6 basal and 9 middle segments of lateral wall （LW）, 8 middle segments of posterior wall （PW） and 5 middle segments of inferior wall （IW）. However, there was no statistically significant difference in subepicardial layer before and after embolization. Accordingly, the ratio of A·β of subendocardial myocardium to subepicardial myocardium in these segments was significantly decreased from 1.10±0.10 to 0.31±0.07 （P〈0.05）. Although the systolic wall thickening did not change 5 min after the embolization in these ischemic segments （29%±3% vs 31%±5%, P〉0.05）, the longitudinal peak systolic velocities （Vs） and early-diastolic peak velocities （Ve） recorded by QTVI were declined significantly （P〈0.05）. Moreover, the subendocardial velocity curves during isovolumic relaxation predominant     

Assessment of coronary artery disease with second harmonic myocardial perfusion contrast echocardiography

Objectives To assess the relationship between myocardial regional perfusion using second harmonic myocardial contrast echocardiography (MCE) by venous injection of Levovist and coronary artery stenosis detected by coronary angiography to determine whether MCE can be used to detect coronary artery disease (CAD) and its sensitivity and specificity for detecting CAD.Methods Thirty-six patients who underwent coronary artery angiography and MCE formed the study groups.Ten myocardial segments (5 each in the apical two- and four-chamber views) from the images were scored for detecting myocardial perfusion as follows: 1, normal perfusion; 2, decreased perfusion; and 3, perfusion defect.The arteries were classified as normal or diseased.The diseased arteries were classified into three groups according to the perfusion scores.Results There were significant differences in coronary diameter stenosis among the different perfusion score groups (P<0.001).There were 10 total occluded arteries, and the myocardial perfusion scores were different because of different collateral circulation.In the normal perfusion group (Group A), the coronary diameter stenosis was 65%±12%, and the myocardial perfusion score index was 1±0.00.In the decreased perfusion group (Group B), the average coronary diameter stenosis was 82%±8%, and the myocardial perfusion score was 1.93±0.16.The diameter stenosis was less than 85% in 63 % of the coronary arteries (including diameter stenosis ≤75% in 12% of the vessels).The diameter stenosis was 85%-90% in 22% of the coronary arteries and >90% in 15% of the arteries.In the perfusion defect group (Group C), the average diameter stenosis was 90%±6%, and the myocardial perfusion score index was 2.89±0.24.The diameter stenosis was　≥85% in 94% of the coronary arteries, and the diameter stenosis was <85% and >75% only in 6% of the coronary arteries.The overall sensitivity and specificity of MCE in identifying angiographic coronary diameter stenosis was 67% and 100%, respectively.The false negative rate was 32.6% for the 108 coronary arteries.Further subdivided analysis showed the sensitivities in Groups A, B and C were 0, 100%, and 100%, respectively.The sensitivity increased with increased lumen diameter stenosis of coronary arteries.Conclusions There is a close relationship between coronary artery stenosis and MCE perfusion scores.MCE with venous injection of new generation contrast can define the presence of CAD and lesion graded classifications.Some disagreements between perfusion score and coronary diameter of stenosis may indicate other factors such as different collateral circulation, which should be further investigated.As artery stenosis increases, the sensitivity of MCE is increased.     

MCE 与2D-STI 评价不同冠状动脉狭窄程度患者的心肌灌注水平与收缩功能

目的： 应用心肌声学造影(myocardial contrast echocardiography,MCE) 与二维斑点追踪技术(twodimensional speckle tracking imaging,2D-STI)评价不同程度冠状动脉狭窄时心肌灌注水平与收缩功能的变化。方法： 选取25 例冠心病患者行MCE,2D-STI及冠状动脉造影检查,各患者心肌节段根据冠状动脉造影中冠状动脉狭窄情况 分为4 组：A组(正常冠状动脉)、B组(轻度狭窄50%~75%)、C组(中度狭窄76%~90%)及D组(重度狭窄91%~100%)。 经过MCE和2D-STI 软件采样及计算,记录每组心肌节段MCE定量指标血容量、血流速度、血流量及2D-STI 定量指 标心肌纵向应变值,并比较其差异。结果： B,C及D组定量指标血流速度、血流量逐渐减小,差异有统计学意义 (P<0.05),A组血容量、血流速度、血流量与B组无明显差异(P>0.05),4 组间心肌纵向应变值差异均有统计学意义 (P<0.05)。结论：MCE及2D-STI 可评价不同冠状动脉狭窄程度的心肌灌注水平与收缩功能,2D-STI 发现冠状动脉轻 度狭窄的能力较MCE更好。     

冠心病超声诊断技术新进展

随着超声新技术的不断发展，超声心动图存冠心病诊断中的应用范围不断扩大，包括：直接经胸超声观察冠状动脉；评价冠脉搭桥术前、术后内乳动脉的功能；心肌声学造影显示心肌灌注，结合负荷试验评估存活心肌；应变率成像评估左室功能；向量速度成像技术测定心室扭转运动及二维应变。这些超声新技术为研究冠心病提供了直观、量化的诊断依据。     

经静脉心肌造影对犬冠状动脉阻断后存活心肌评价的实验研究

目的:探讨经静脉心肌造影(MCE)对犬冠状动脉阻断后存活心肌判定的价值。方法:应用自制声学造影剂,对12条犬于冠状动脉阻断即刻、阻断后1h、4h和再灌注后1h进行经静脉心肌造影研究。结果:当冠状动脉阻断后,所有犬阻断的冠状动脉供血区心肌出现节段性的灌注缺损。阻断即刻与1h的灌注缺损区面积无明显差异,而阻断4h后灌注缺损面积较前两者变小,在阻断早期灌注缺损区域部分变为正常或灌注减低区。灌注减低区对应的氯化三苯四氮唑染色显示为存活心肌。结论:冠状动脉阻断一定时间后MCE可以准确判定存活心肌。     

Evaluation of the left ventricular remodeling in patients with myocardial infarction after revascularization with intravenous real-time myocardial contrast echocardiography

In order to evaluate the left ventricular remodeling in patients with myocardial infarction after revascularization with intravenous real-time myocardial contrast echocardiography （RT-MCE）, intravenous RT-MCE was performed on 20 patients with myocardial infarction before coronary revascularization. Follow-up echocardiography was performed 3 months after coronary revascularization. Segmental wall motion was assessed using 18-segment LV model and classified as normal, hypokinesis, akinesis and dyskinesis. Myocardial perfusion was assessed by visual interpretation and divided into 3 conditions： homogeneous opacification=l; partial or reduced opaciflcation or subendocardial contrast defect=2; constrast defect=3. Myocardial perfusion score index （MPSI） was calculated by dividing the total sum of contrast score by the total number of segments with abnormal wall motion. Twenty patients were classified into 2 groups according to the MPSI： MPSI≤I.5 as good myocardial perfusion, MPSI〉1.5 as poor myocardial perfusion. To assess the left ventricular remodeling, the following comparisons were carried out： （1） Comparisons of left ventricular ejection fraction （LVEF）, left ventricular end-systolic volume （LVESV） and left ventricular end-diastolic volume （LVEDV） before and 3 months after revascularization in two groups;（2） Comparisons of LVEF, LVESV and LVEDV pre-revascularization between two groups and comparisons of these 3 months post-revascularization between two groups; （3） Comparisons of the differences in LVEF, LVESV and LVEDV between 3 months post-and pre-revascularization （ALVEF, ALVESV and ALVEDV） between two groups; （4） The linear regression analysis between ALVEF, ALVESV, ALVEDV and MPSI. The results showed that the LVEF obtained 3 months after revascularization in patients with MPSI〉1.5 was obviously lower than that in those with MPSI〈1.5. The LVEDV obtained 3 months post-revascularization in patients with MPSI〉1.5 was obviously larger than that in those with M     

Quantitative analysis of myocaridal perfusion in rabbits by tansthoracic real-time myocardial contrast echocardiography

To evaluate the feasibility of real-time myocardial contrast echocardiography （RTMCE） by quantitative analysis of myocardial perfusion in rabbits, transthoracic RTMCE was performed in 10 healthy rabbits by using continuous infusion of SonoVue into the auricular vein. The short axis view at the papillary muscle level was obtained. The duration of the time that the contrast took to appear in right heart, left heart and myocardium was recorded. The regional myocardial signal intensity （SI） versus re-filling time plots were fitted to an exponential function： y（t） =A（1–e–β（t–t0）） ＋ C, where y is SI at any given time, A is the SI plateau that reflects myocardial blood volume, and β is the slope of the refilling curve that reflects myocardial microbubble velocity. The A, β and A×β values at different infusion rate of SonoVue were analyzed and the A, β and A×β values in each segment in the short axis view at the papillary muscle level were compared. All the animal experiments were successful and high-quality im-ages were obtained. The best intravenous infusion rate for SonoVue was 30 mL/h. The contrast appeared in right heart, left heart and myocardium at 7.5±2.2 s, 9.1±2.4 s and 12.2±1.6 s respectively. After 16.6±2.3s, myocardial opacification reached a steady state. The mean A, β and A×β value in the short axis view at the papillary muscle level were 9.8±3.0 dB, 1.4±0.5 s-1 and 13.5±3.6 dB×s-1 respectively. A, β and A×β values showed no significant differences among 6 segments. It was suggested that RTMCE was feasible for quantitative analysis of myocardial perfusion in rabbits. It provides a non-invasive method to evaluate the myocardial perfusion in rabbit disease models.     

Evaluation of Myocardial Viability after Myocardial Infarction with Intravenous Real-time Myocardial Contrast Echocardiography

The myocardial viability after myocardial infarction was evaluated by intravenous myocardial contrast echocardiography. Intravenous real-time myocardial contrast echocardiography was performed on 18 patients with myocardial infarction before coronary revascularization. Follow-up echocardiography was performed 3 months after coronary revascularization. Segmental wall motion was assessed using 18-segment LV model and classified as normal, hypokinesis, akinesis and dyskinesis. Viable myocardium was defined by evident improvement of segmental wall motion 3 months after coronary revascularization. Myocardial perfusion was assessed by visual interpretation and divided into 3 conditions： homogeneous opacification; partial or reduced opaciflcation or subendocardial contrast defect; contrast defect. The former two conditions were used as the standard to define the viable myocardium. The results showed that 109 abnormal wall motion segments were detected among 18 patients with myocardial infarction, including 47 segments of hypokinesis, 56 segments of akinesis and 6 segments of dyskinesis. The wall motion of 2 segments with hypokinesis before coronary revascularization which showed homogeneous opacification, 14 of 24 segments with hypokinese and 20 of 24 segments with akinese before coronary revascularization which showed partial or reduced opaciflcation or subendocardial contrast defect was improved 3 months after coronary revascularization. In our study, the sensitivity and specificity of evaluation of myocardial viability after myocardial infarction by intravenous real-time myocardial contrast echocardiography were 94.7% and 78.9%, respectively. It was concluded that intravenous real-time myocardial contrast echocardiography could accurately evaluate myocardial viability after myocardial infarction.     

犬壁冠状动脉及心肌桥的形态观测

目的探讨犬壁冠状动脉和心肌桥的形态学特点,为比较解剖学提供依据。方法犬心41例,10%的甲醛溶液固定,大体解剖显示犬心冠状动脉及其分支,观测心肌桥及壁冠状动脉的出现率。结果41例犬中,29例(70.7%)出现冠状动脉心肌桥,多出现于前室间支(79.3%)、后室间支、左室前支,心肌桥厚度为0.56±0.61 mm。前室间支冠状动脉前段内径1.64±0.46 mm,厚度0.18±0.06 mm;壁冠状动脉内径1.35±0.46 mm,厚度0.13±0.04 mm。心肌桥近段距第一对角支距离为19.78±8.20 mm,距前室间支起始部距离为24.49±12.37 mm,距右冠起始部距离为24.21±5.80 mm。心肌桥纤维走向与壁冠状动脉夹角为68.94±14.38度。结论犬冠状动脉心肌桥出现率及位置与人相似,可作为心脏实验动物模型。     

改良左旋支结扎法微创小型猪急性心肌梗死模型建立与评估

目的 应用改良的左冠状动脉回旋支结扎方法联合微创手术,制备小型猪急性心肌梗死模型,评估其有效性和稳定性,并探讨其在科研应用中的意义。方法 选择3月龄巴马香猪25头,麻醉下行气管插管呼吸机辅助通气,微创开胸结扎左旋支中段,建立急性心肌梗死模型。并于术前、术后1 h、4周行心脏超声评估模型动物的心脏功能,术后4周处死动物,取心脏行TTC染色评估梗死面积及病理变化,统计死亡率和死亡原因。结果 结扎术后1 h和4周后心脏功能较术前均明显降低,EF值由（64.2±4.6）%分别降至（48.2±5.3）%和（49.7±6.1）%（P<0.01）,左心室侧壁室壁厚度变薄,胶原增生。梗死后1 h室颤率17.3%,梗死面积为（19.2±3）%。结论 应用改良的左冠状动脉回旋支结扎方法联合微创手术能够建立稳定的猪心肌梗死模型,具有手术创伤小、模型稳定和死亡率低等特点,为相关研究提供了经济、理想的动物模型。     

Value of Acceleration Flow in the Left Anterior Descending Coronary Artery for the Detection of Coronary Artery Stenosis by Transthoracic Coronary Color Doppler Echocardiography

Transthoracic color Doppler echocardiographyhas been widely used to measure the coronary ar-tery flowvelocity reserve[1].It is useful to providei mportant informationfor diagnosis of coronary ar-tery disease and assessment of curative effect afterpercutaneous coronary artery intervention.Butthis evaluats onlythe effect of the stenosis on coro-nary artery flow velocity reserve during maxi malhyperemia reaction.Hemodynamics demonstratesthat localized flow acceleration is present at thestenotic s…     

不停跳冠脉搭桥心肌保护技术在瓣膜疾病合并冠心病手术中的应用

  目的   介绍不停跳冠脉搭桥心肌保护技术在瓣膜疾病合并冠心病手术中的应用。   方法   观察2017年1月—2020年7月就诊于中国科学技术大学附属第一医院心脏外科的瓣膜病合并冠心病的149例患者,应用不停跳冠脉搭桥心肌保护技术行瓣膜置换合并冠脉搭桥术的手术效果和相关并发症。对于搭桥+主动脉瓣膜/双瓣膜置换术,经左、右冠状动脉开口直接灌注+经静脉桥血管灌注,然后行心脏瓣膜置换术,缝合主动脉切口+静脉桥血管吻合。对于搭桥+二尖瓣膜置换手术,将静脉桥血管吻合至主动脉,降温阻断后,行主动脉根部灌注和二尖瓣膜置换。   结果   149例手术患者中,主瓣+搭桥49例,二尖瓣+搭桥83例,双瓣+搭桥17例,单支冠脉病变需搭桥54例,2支病变55例,3支病变40例。术后住院期间死亡10例,术后有4例发生永久性脑卒中,有28例发生急性肾功能不全需透析治疗,有18例机械通气时间>24 h。   结论   对于冠心病合并瓣膜病的患者,在冠状动脉搭桥合并瓣膜手术中应用不停跳冠脉搭桥心肌保护技术具有操作简单、手术效果满意、术后并发症少及临床效果满意等优点。       

心脏超声与心肌血流储备分数诊断冠心病心肌缺血的价值

目的 探讨心脏超声节段性室壁运动异常与心肌血流储备分数（fraction flow reserve,FFR）诊断冠心病心肌缺血的临床应用价值。 方法 回顾性选取95例疑似冠心病心肌缺血患者的临床资料进行研究,经冠状动脉造影确诊为冠心病心肌缺血共52例;均予以心脏超声检查与FFR的检测,进一步分析对比两种检测指标的阳性预测值、阴性预测值、准确率、特异度、敏感度,分析其ROC曲线。 结果 95例疑似冠心病心肌缺血患者经心脏超声检查后其阳性预测值为81.63%,阴性预测值为73.91%;低于金标准（P＜0.05）;经FFR检测后其阳性预测值为96.15%,阴性预测值为95.35%;与金标准相比差异无统计学意义（P＞0.05）。FFR法的敏感度、特异度、准确度均高于心脏超声（P＜0.05）。心脏超声检出前降支病变共15例（71.43%）、回旋支病变共12例（75.00%）、右冠状动脉病变共13例（86.67%）;FFR检出前降支病变共20例（95.24%）、回旋支病变共15例（93.75%）、右冠状动脉病变共15例（100.00%）;两种方法的总检出率比较,差异有统计学意义（P＜0.05）。心脏超声节段性室壁运动异常的曲线下面积AUC值为（0.780,P＜0.05）;FFR的曲线下面积AUC值为（0.958,P＜0.05）。 结论 心脏超声节段性室壁运动异常与FFR相比,后者预测价值更高,能为冠心病心肌缺血的诊断提供客观依据。     

冠状动脉支架置入术前后心肌二维应变的变化分析

目的 应用二维应变定量分析冠状动脉支架置入术前后局部心肌功能,探讨其临床应用价值.方法 选取2009年10月至2010年12月在邯郸市中心医院住院确诊的冠状动脉粥样硬化性心脏病患者50例.分析比较各节段心肌在冠状动脉支架置入术前、术后1周和术后1个月的收缩期峰值纵向应变和径向应变值.结果 冠心病患者术后1个月的左心室射血分数、左心室内径缩短率较术前和术后1周有所提高,但差异无统计学意义;治疗后1个月的收缩期峰值纵向和径向应变值均高于治疗前,除前壁基底段外,其余心肌节段之间的差异有统计学意义;治疗后1周收缩期峰值纵向和径向应变值较治疗后1个月,除前间隔、后壁各段外,差异均无统计学意义.结论 超声斑点追踪成像技术可以客观地测量节段心肌的收缩期峰值纵向、径向应变,为评价冠状动脉支架置入术的临床疗效提供了客观依据.     

Impact of primary percutaneous coronary intervention on blood perfusion in nonculprit artery in patients with anterior ST elevation myocardial infarction

Background Recent studies have demonstrated that epicardial flow in nonculprit arteries,which has been assumed to be normal,was slowed in the setting of ST-elevation myocardial infarction (STEMI).Howev...     

Hydrogen peroxide myocardial perfusion contrast echocardiography: I. Experimental study

Summary Myocardial perfusion contrast two-dimentional echocardiography (2-DE) is a new method for determining the extent of experimental myocardial ischemia and infarction. 172 aortic root injections of a fresh mixture of 1 ml of 0.75 % hydrogen peroxide (H₂O₂) and blood, and 75 pulmonary wedge injections of 1 ml of 3 % H₂O₂ were given to 24 open-chest dogs before and after ligation of the left anterior descending coronary artery (LAD) and four short-axis and long-axis views of the left ventricle were examined. 164 (95%) aortic root injections and 30 (40 %P< 0.05) pulmonary wedge injections showed homogeneous echocardiographic contrast intensification of normal myocardium before ligation of LAD and distinctly delineated echocardiographic contrast defect after ligation of LAD. When compared with aortic root injection, H₂O₂ pulmonary wedge injection has the adventage of less invasiveness and remains to be further studied. This project was supported by the Science Fund of the Chinese Academy of Sciences     

Preliminary results of combined carotid endarterectomy and off-pump coronary artery bypass grafting in patients with coexistent carotid and coronary artery diseases

Background Coexistent carotid and coronary artery diseases are common and patients with them remain at a high risk for perioperative stroke or myocardial infarction after coronary bypass surgery. The aim of this study was to investigate the effect of combined carotid endarterectomy （CEA） and off-pump coronary artery bypass grafting （CABG） in patients with coexistent carotid and coronary artery diseases. Methods Between January 2002 and December 2007, consecutive patients with coexistent carotid and coronary artery diseases underwent one-stage unilateral CEA and off-pump CABG in Heart Institute of Nanjing First Hospital Affiliated to Nanjing Medical University. Perioperative complications were assessed and follow-up was carried out. Results A total of 51 cases of isolated off-pump CABG and unilateral CEA, including 34 right and 17 left, were performed. The mean blocked time of carotid artery in CEA was （25.5_±7.0） minutes. The mean number of distal grafts per patient was 3.30±0.45. The mean ventilation time, intensive care unit stay, and postoperative hospital stay was （11.3±5.4） hours, （2.1±0.9） days, and （12.5±6.1） days respectively. None of the patients had stroke or myocardial infarct. There was one perioperative death due to acute cardiac failure, resulting in an operative mortality of 1.96%. Follow-up was completed for 47 patients （92.16%） with a mean follow-up of （39.5±12.5） months. None of the patients manifested stroke, new angina or newly developed cardiac infarct. No late death occurred. Conclusion Combined CEA and off-pump CABG is a safe and effective procedure in selected patients with coexistent carotid and coronary artery diseases.     

冠状动脉旁路移植术后心肌缺血损伤的评估

目的观察急性心梗及心脏手术后肌钙蛋白（IcTnI）的变化情况,以了解两种情况下影响cTnI升高的机制是否相同。方法检测30例急性心梗（AMI）患者胸痛发作4h、6h、12h、24h、48h、72h、96h及1周时cTnI的变化,以及30例非体外循环冠脉搭桥术（OPCABG）患者术中吻合血管前、关胸即刻（0h）、术后3h、6h、12h、24h、48h、72h、96h以及术后1周cTnI的变化情况,将术后患者分为术后心梗患者（PMI）、术后心绞痛患者以及术后无症状患者,制作变化曲线进行对比。结果术后心梗患者cTnI变化曲线上升支较急性心梗组陡直,下降支较急性心梗组变化平缓,表明术后cTnI清除速度下降。术后心绞痛患者与术后无症状患者,cTnI均有不同程度的升高,但组间的cTnI差异无统计学意义。术后无症状患者与AMI组比较,峰值提前。结论根据术后cTnI的变化,进行危险分层,评估预后,分层管理,指导临床术后处理,并作为治疗效果的监测途径,提高手术效果,改善患者预后。     

升主动脉钙化冠心病合并心肌桥12例临床分析

目的：分析升主动脉钙化冠心病合并心肌桥的外科治疗效果。方法：对12例升主动脉钙化冠心病合并心肌桥患者施行冠状动脉旁路移植术和心肌切开术,12例患者均存在不同程度的升主动脉钙化,术中将血管桥近端吻合在降主动脉上,对于较浅的心肌桥在非体外循环下行心肌切开术,而对于走形于心肌深部的肌桥,采用体外循环下冠状动脉旁路移植术;血管段同时合并狭窄及肌桥时,在心肌桥远侧的部位进行冠状动脉旁路移植术。结果：所有患者均手术顺利,无严重并发症,术后随访未出现心脏不良反应。结论：升主动脉钙化冠心病合并心肌桥者选择适当的手术方式可取得令人满意的近期效果,其远期疗效还有待于进一步观察。