冠状动脉夹层(附14例报告)

目的：探讨冠状动脉夹层的造影表现、分型与临床预后的关系。材料和方法：１４例中男１３例、女１例。临床诊断冠心病，其中９例有心肌梗塞史。冠状动脉造影均显示内膜撕裂瓣片形成的线样透亮线；其中１２例为ＰＴＣＡ术后。结果：轻度内膜撕裂３例、平行夹层分离４例、局限型夹层分离５例、螺旋型分离２例。１４例中９例假腔内造影剂排空正常或轻度排空延迟，真腔无明显受压，病人无重要临床并发症。５例假腔造影剂排空延迟，真腔中－重度受压，其中３人出现急性心肌缺血和心肌梗塞体征。结论：结合临床预后冠状动脉夹层可分为真腔受压和真腔无明显受压两大类，后者一般不产生严重临床症状和体征；而前者可产生严重临床并发症，需要紧急治疗。

Coronary Dissection (Report of 14 Cases)

Purpose: To evaluate the angiographic appearance of coronary dissection and its classification with prediction of clinical outcome. Materials and Methods: 14 cases clinically diagnosed as coronary arteriosclerotic cardiopathy were collected including 9 myocardial infarction. Male to females ratio was 13 to 1. The coronary angiography of 14 cases all showed linear radiolucent areas of intimal disruption. There were 12 cases, the dissection was resulted from percutaneous transluminal coronary angioplasty. Results: Small intimal disruptions were found in 3 cases, and parallel dissection tracts were seen in 4 cases, while spiral luminal filling defects were shown in 2 cases. The false lumen of coronary dissection during contrast injection were minimal or not persistent after dye clearance and true lumen were not narrowed in 9 cases. Complication in this group were low, compared with complication rates in other group. The false lumen of coronary dissection during contrast injection were still filled with contrast material after clearance of dye form the coronary artery lumen and true lumen were moderately or seriously narrowed in 5 cases, 3 cases had acute myocardial ischemia and myocardial infarction in this group. Conclusion: Coronary dissection can be classified as having stenosed true leman or normal true leman. The latter, the clinical complications were low or absent but in the former there might be some significant clinical complications which required emergency treatment.