核素心肌灌注显像与多层螺旋 CT 诊断冠心病的对比分析

目的 对比分析核素心肌灌注显像(MPI)与多层螺旋CT(MSCT)对冠心病(CAD)的诊断价值,并评价两者联合诊断CAD的临床价值.方法 对43例患者(疑诊CAD 36例,确诊CAD 7例)行冠状动脉造影(CAG)、MPI和MSCT检查,且三项检查均在2个月内进行.采用半定量法对MPI结果 进行分析,SDS(总差值分)>1判定为可逆性心肌缺血,并将各心肌节段定位于其所对应的冠状动脉;参照国际上通用的目测直径法对MSCT结果 进行判定,即至少1支主要冠状动脉或其主要分支狭窄程度≥50%判定为阳性.以CAG为诊断CAD的"金标准",比较MPI与MSCT对CAD患者的诊断价值和对病变血管(狭窄程度≥50%)的检出价值.结果 MPI和MSCT对CAD患者诊断的灵敏性、特异性及准确性分别是79.17%、84.21%及81.40%和83.33%、89.47%及86.05%;MPI和MSCT对病变血管诊断的灵敏性、特异性及准确性分别是53.19%、89.02%及75.97%和70.21%、95.12%及86.05盼,两者差异均无统计学意义(P>0.05).结论 MPI和MSCT诊断CAD差异无统计学意义.两者优势互补,是筛选、诊断CAD的无创性检查手段,宜结合使用.     

Angiographic and echocardiographic observations in surgical patients with atrial myxoma

In a series of 18 patients with atrial myxoma (16 left, 2 right) the tumors were consistently identified by right ventriculography and generally visualized by left ventriculography in patients with left atrial myxoma examined owing to concomitant mitral insufficiency caused by tumor invasion at the site of mitral valve closure. Echocardiography was suited to early diagnosis of suggested tumor. Pseudoaneurysms in the cerebral and coronary arteries, apparently caused by myxomatous emboli with weakening of vessel lumen, were noted in several patients; therefore, selective coronary and cerebral arteriography should be performed preoperatively in patients with symptoms of thromboembolism. We stress that echocardiography should be performed routinely after surgery to disclose recurrences, while arteriographic control studies should be added in cases with vascular anomalies seen peeoperatively.     

经皮股动脉穿刺插管术应用于升主动脉及左室造影

经皮股动脉穿刺插管23例,穿刺成功率达95.7%,比切开动脉的方法优越。术前准备的好坏,对穿刺插管的成功率有很大影响。     

共同动脉干的MRI诊断及影像学比较

目的 与其他影像方法比较，探讨MRI诊断共同动脉干的价值，提高无创诊断水平。方法 共同动脉干12例，根据肺动脉由动脉干分出的部位分型；12例均行X线平片、超声心动图(UCG)和MR检查，并均经心血管造影(CAG)证实，6例经手术进一步证实。结果 I型4例，Ⅲ型2例，Ⅳ型6例。X线平片考虑5例共同动脉干可能，UCG正确诊断I型4例，Ⅲ型2例未能探及肺动脉起自动脉干的部位，Ⅳ型中正确诊断3例。MRI正确诊断10例，只有Ⅳ型2例误诊，MRI可显示共同动脉干心内结构和肺动脉起源于动脉干的部位。结论 MRI在共同动脉干诊断中有一定应用价值，可弥补UCG在共同动脉干诊断中的不足，二者结合使用可提高临床对共同动脉干的无创诊断水平。     

多层螺旋CT血管成像对主动脉夹层的诊断及术后随访价值

目的：探讨多层螺旋CT血管成像（MSCTA）对主动脉夹层的诊断及术后随访的价值。方法：对46例主动脉夹层（其中11例有术前及术后对照）患者进行了MSCTA胸腹联合检查，将原始数据初步重建后传到工作站进行多平面重建（MPR）、最大密度投影（MIP）及容积再现（VR）等后处理。结果：46例均满意地显示了主动脉夹层的部位和范围，真腔、假腔、内膜片及撕裂口均能得到清楚显示；11例术后显示管腔复张及支架位置良好，4例再发其他部位夹层。结论：MSCTA对主动脉夹层的术前诊断及术后随访均具有较高的临床应用价值，可作为诊断主动脉夹层的首选检查方法。     

中药通心络对猪急性心肌梗死再灌注后无再流的影响

目的评价通心络防治猪急性心肌梗死(AMI)再灌注后无再流的作用。方法中华小型猪40只随机分成5组,每组8只:(1)AMI模型对照组(对照组),(2)通心络小剂量治疗组(0·05g·kg-1·d-1),(3)通心络中剂量治疗组(0·2g·kg-1·d-1),(4)通心络大剂量治疗组(0·5g·kg-1·d-1),(5)假手术组。通心络各组预给药3d后行冠状动脉结扎180min,松解60min制备AMI再灌注模型。AMI前、后和再灌注后均行血流动力学测定,心肌声学造影(MCE)检查和病理学分析。结果(1)与AMI前相比,对照组AMI后180min左室收缩压(LVSP)、心排量和左心室内压最大收缩和舒张变化速率(±dp/dtmax)均显著下降(P<0·05或P<0·01),左室舒张末压(LVEDP)显著升高(P<0·01);再灌注后60min仅LVSP显著恢复(P<0·05),然而±dp/dtmax继续显著下降(P<0·05)。小、中和大剂量通心络组AMI后180min各项指标变化与对照组相同;再灌注后60min仅大剂量通心络组LVEDP、±dp/dtmax和心排量均显著恢复(均P<0·05),且显著好于对照组(均P<0·05)。(2)对照组MCE和病理染色所测的冠脉结扎区心肌范围(LA)高度一致(P>0·05),再灌注后无再流区范围分别为78·5%和82·3%,心肌坏死面积占结扎区心肌面积的98·5%。3个通心络组LA与对照组相当(均P>0·05),但MCE和病理染色所测无再流范围在中及大剂量通心络组分别为41·1%、42·4%和24·1%、25·0%,坏死心肌范围分别为90·2%及81·2%,均显著小于对照组和小剂量组(P<0·05或P<0·01),大剂量组也显著小于中剂量组(P<0·05或P<0·01)。(3)对照组再灌注后即刻和再灌注后60min冠脉血流量仅占AMI前的45·8%和50·6%(均P<0·01),而大剂量通心络组冠脉血流量分别占AMI前的76·0%和73·5%,均显著高于对照组(均P<0·01)。结论通心络能有效地防治心肌梗死再灌注后无再流,缩小梗死面积;中剂量有效,大剂量更好。     

Transcardiac conductance for continuous measurement of left ventricular volume: validation vs. angiography in patients

Objective To test the feasibility of the transcardiac conductance (TCC) method for continuous, on-line measurement of absolute left ventricular (LV) volume and to validate the method by comparison with biplane angiography.Design and setting Prospective clinical feasibility and validation study in a cardiac catheterization laboratory in a university hospital.Patients and interventions Ten patients scheduled for electrophysiological studies (n=5), percutaneous transluminal coronary angioplasty (n=3), and left- and right-sided cardiac catheterization (n=2) were enrolled in the feasibility study. Twenty patients scheduled for diagnostic left- and right-sided cardiac catheterization were included in the validation study. The latter were studied at baseline and during right atrial pacing 30 beats/min above baseline.Measurements and results In the feasibility study satisfactory ventricular volume signals were obtained by TCC in eight of ten patients. In the validation study calibration factors ( and V^p) for TCC were obtained by thermodilution and hypertonic saline dilution, to yield absolute LV volume. Results indicate a good linear correlation with angiographic volume (R²=0.78) with an intercept of 10±15 ml, not significantly different from 0 and slope of 1.17±0.16. Mean calibration factors and V^p were 0.017±0.002 (interpatient variability 0.018) and 75.1±0.4 ml (interpatient variability 35.4 ml), respectively.Conclusions The TCC method provides on-line and continuous LV volume signals in patients in a relatively noninvasive way. Calibration yields absolute LV volumes with a good linear correlation in comparison to biplane LV angiography. TCC appears to be a promising methodology for monitoring absolute LV volume in the ICU.This research was supported by a grant from The Netherlands Heart Foundation (NHS 98-151); J.W.J. is an established clinical investigator of The Netherlands Heart Foundation (2001-D032)     

主动脉弓离断三联征的放射诊断

目的：分析与评价主动咏弓离断(IAA)三联征的影像学表现及其诊断价值。方法：回顾性分析20例患者的X线平片、心导管检查和心血管造影资料,其中7例行电子束CT检查,11例行手术治疗,逐个分析其X线平片征象并与心血管造影及手术结果对照。结果：X线胸片显示肺血多,肺动脉段明显凸出和心脏增大(n=20);右上纵隔大血管影变窄(n=16);主动脉结观察不清(n=16);侧位或左前斜位见低位主动脉弓(n=12);降主动脉的顶端与主肺动脉处同一水平(n=8)。心导管检查均提示肺动脉高压、主动脉弓畸形、动脉导管未闭。心血管造影诊断IAA(A型)13例,IAA(B型)5例,其中合并主肺间隔缺损4例,合并右室双出口2例,右肺动脉起源异常1例。结论：X线平片对该畸形的诊断有一定的价值,多数病例可作诊断,心血管造影是诊断该病的最可靠方法。     

三房心的影像学诊断(附12例报告)

目的 评价经胸二维超声心动图（２Ｄｅｃｈｏｃａｒｄｉｏｌｉｏｇｒａｐｈｙ,２ＤＥ）、心血管造影（ｃａｒｄｉｏａｎｇｉｏｇｒａｐｈｙ,ＣＡＧ）和ＭＲＩ在三房 的作用。方法 经手术证实的三房心１２例,其中支经胸２ＤＥ检查１２例,ＣＡＧ检查６例,ＭＲＩ检查８例。结果 ３种影像方法正确诊断三房心分别为经２ＤＥ７例（７／１２）,ＣＡＧ４例（４／６）,ＭＲＩ８例（８／８）。ＭＲＩ能较地显示左房内的异常隔膜和隔