冠状动脉造影检出心肌桥的方法探讨

目的探讨提高心肌桥冠状动脉造影检出率的方法.方法研究对象为t999年9月至2000年12月复旦大学附属中山医院所有接受冠状动脉造影的731名病人.方法(1)左冠状动脉造影用右前斜位、右前斜+头位、右前斜+足位、左前斜+足位、左前斜+头位,必要时加用后前+头位.右冠状动脉造影用左前斜、右前斜位;(2)至少二位有经验者同时观察;(3)对LAD近段固定性狭窄者植入支架后再造影观察;(4)对可疑者冠状动脉内注射硝酸甘油后再造影.结果731例病人中检出心肌桥67例,检出率为9.17%,显著高于文献报道的冠状动脉造影对心肌桥的检出率.心肌桥均位于前降支.有16例病人(23.9%)在壁冠状动脉近段有固定性的狭窄,植入支架后复行造影显示了原先不明确的心肌桥.有28例可疑者(41.8%)冠状动脉内注射硝酸甘油200μg后明确显示心肌桥.结论冠状动脉造影中采用多个投照体位,有经验者观察,对LAD近段固定性狭窄病变植入支架后常规复行造影和对可疑者冠状动脉内注射硝酸甘油后再造影观察,可以增加对心肌桥的检出率.

Evaluating the skills for detecting angiographyically-demonstrated myocardial bridging

Objective To Study skills of detecting angiographyically demonstrated myocardial bridging Methods Selective coronary angiograms were performed on 731 patients at Affiliated Zhongshan Hospital of FuDan University in the 16 month period between Sept of 1999 and Dec of 2000 (1)Multiple views of coronary angiography were used (2)The coronary angiograms were at least examined by two experienced cardiologists (3)The coronary angiography was repeated after stent implantation if there was stenosis in the segment proximal to bridging (4)Nitroglycerin was injected intracoronarilly for uncertain case Results Angiographic evidence of myocardial bridging over left anterior descending was noted in 67 of 731 consecutive coronary arteriograms The incidence of myocardial bridging was 9 17%, which is higher than that in literatures reported The myocardial bridges were detected only after stent implantation in 16 patients (23 9%) with stenosis proximal to bridging The uncertainly myocardial bridges became definite only after injecting of nitroglycerin into coronary in 28 patients (41 8%) Conclusion Detecting of angiographyically demonstrated myocardial bridging could be improved by multiple views, observed by experienced operators, by repeating angiograms after stent implantation and by injecting of nitroglycerin intracoronarilly for uncertain cases