目的:探讨彩色多普勒超声在诊断冠状动脉造影术后引发的医源损伤性假性动脉瘤的临床价值。方法: 经股动脉穿刺,行冠状动脉造影术而发生的股动脉假性动脉瘤共39例,所有患者都采用高频彩色多普勒诊断仪,对动脉瘤的二维超声图像、彩色多普勒图像及脉冲多普勒图像进行分析。结果: 39例假性动脉瘤患者在穿刺部位动脉的一侧均显示一搏动性无回声区或混合性低回声区;彩色多普勒显示无回声区内呈涡流或旋转样血流信号,表现为一半红色一半蓝色;脉冲多普勒显示典型的双期双向频谱。39例假性动脉瘤彩色多普勒超声诊断完全明确。其中32例在彩色多普勒超声监控下行人工加压包扎修复。7例经血管外科手术修补治疗。结论: 彩色多普勒超声在诊断冠状动脉造影术后造成的医源损伤性假性动脉瘤,在观察动脉瘤的大小、形态、瘤体的结构,判断来源动脉破口定位上准确、简便、无创,且可在超声引导下行安全无创治疗,可作为该病诊断及治疗的首选方法。
Objective To investigate the relation of spinal ventricular septal angle (SVSA) measured by computer tomographic pulmonary angiography (CTPA) and pulmonary vascular resistance (PVR) measured by right heart catheterization in patients with chronic thromboembolic pulmonary hypertension (CTEPH) .Methods Eighty-nine patients with CTEPH (male 57, female 32; 53.08 ±12.43 years) were recruited as a CTEPH group, and 89 patients without pulmonary artery hypertension and pulmonary embolismwere recruited as a control group. The CTEPH patients received CTPA before right-heart catheterization and pulmonary angiography. SVSA and pulmonary artery obstruction indexes including Qanadli Index and Mastora index were evaluated by two radiologists.Results SVSA was 65.13°±12.26°and 39.69°±5.84°in the CTEPH group and the control group respectively, with significant difference between two groups ( t =14.479, P = 0.000) . Qanadli index of the CTEPH patients was( 42.50 ±17.67) % , which had no correlation with SVSA ( r= 0.094, P = 0.552) . Mastora index was ( 30.02 ±15.53) % , which also had no correlation with SVSA ( r=0.025, P =0.873) . SVSA had a moderate positive correlation with PVR ( r =0.529, P =0.000) and a weak positive correlation with right atriumpressure ( r =0.270, P =0.010) . Area under ROC was 0.764 and sensitivity, specificity for PVR≥1000 dyne· s· cm- 5 was 0.714 and 0.778 respectively when SVSA≥67.55°. Conclusion SVSA measured by CTPA can be used as a better predictor for evaluating PVR in CTEPH patients.
ObjectiveTo explore coronary angiographic characteristics in patients with symptomatic recurrence after coronary artery bypass grafting (CABG). MethodsWe performed a retrospective study of 997 patients with symptomatic recurrence after CABG in Beijing Anzhen Hospital from 2010 to 2020. There were 762 males and 235 females, with an average age of 62.41±8.70 years.ResultsThere was a high prevalence of risk factors like hypertension, diabetes and a history of smoking. Diseased arterial grafts accounted for 27.44% while saphenous vein graft 54.40%; 240 (24.07%) patients had all patent grafts. The main lesion characteristics of diseased grafts were chronic total occlusion lesions (79.57%). Most patients had more diseased native vessels after CABG than before. The type C coronary artery disease in native vessels relevant to ischemic area occurred in 674 (67.60%) patients; 525 (52.66%) patients with recurrent symptom after CABG had both diseased grafts and diseased native vessels. Conclusion Graft status in patients with symptomatic recurrence after CABG is worse than we expected. The majority have newly developed lesions both in grafts and native vessels. Native vascular lesions will continue to progress after CABG.
摘要:目的:评价64层螺旋CT对冠心病的诊断价值。方法:对25例典型病例的CT图片进行分析、总结,观察64层螺旋CT对冠状动脉的管腔狭窄程度及冠脉内斑块性质的显示能力,并对桥血管和支架通畅性进行观察。结果:近端冠脉中度以上狭窄的敏感度、准确度、阳性预测值分别为93.5%,90.3%,88.5%,对左主干及前降支病变诊断价值较高;对冠状动脉内软斑块显示较佳;对桥血管及支架通畅和有无再狭窄显示良好。结论:MSCT冠状动脉成像在冠心病筛查及冠状动脉支架术后和搭桥术后的随访发挥重要作用。Abstract: Objective: To study the diagnose value of 64slice spiral CT for coronary heart disease. Methods:The CT pictures of 25 typical cases of coronary heart disease were analyzed so as to survey the displaying ability coronal arterial stenosis, its degree and the character plaques, the patency of bypass graft and stents by 64slice spiral CT. Results:The sensitivity, accuracy, positive predictive value for RCA1 narrow above moderate was 93.5%, 90.3%, 88.5% respectively. For LM and LAD, its diagnose value was high. The coronary soft or fibrous plaque, stent and bypass graft were displayed well. Conclusion:MSCT plays an important role in filtering coronary heart disease and reexamination after stents and bypass.
Objective To explore the value of CT obstruction index ( CTI) on CT pulmonary angiography( CTPA) in estimating the severity of acute pulmonary embolism. Methods 27 patients with pulmonary embolism were retrospectively studied. Pulmonary embolism was diagnosed by CTPA. The correlations between CTI and arterial blood gas and shock index ( SI) were assessed by Spearman rank correlation analysis. Blood gas values and SI were comparatively evaluated belowand above different CTI cutoffvalues( 30% , 40% , 50% , and 60% , respectively) . Results A significant correlation was found between CTI and PaO2 ( r = - 0. 416, P =0. 031) , and also between CTI and P( A-a) O2 ( r =0. 468, P =0. 014) . PaO2 ( P =0. 027) and P( A-a) O2 ( P = 0. 034) were significantly different between pulmonary embolism patients above and below the CTI 60% cutoff value( P lt;0. 05) . Conclusions CTI is an effective index to evaluate the severity of pulmonary embolism. CTI gt;60% might be an indicator of higher severity.
ObjectiveTo explore the status,reasons and precautions of misdiagnosis of pulmonary sequestration. MethodsSeventy-seven articles about pulmonary sequestration published in Wanfang and CNKI databases between January 2005 and December 2013 were retrospectively analyzed,of which 41 articles referring to misdiagnosis rate.The misdiagnosis rate,time,status,consequence,reason and main means of definite diagnosis were analyzed. ResultsThe total number of cases of pulmonary sequestration in the 41 articles was 689,in whom 399 cases were misdiagnosed.Misdiagnosis rate was 57.91%.The minimum misdiagnosis time was 14 days and the maximum was 40 years.Pulmonary sequestration was most often misdiagnosed as pulmonary cyst(23.16%),bronchiectasis(22.73%),lung cancer(20.08%),lung abscess(6.93%)and pneumonia(6.28%).Most misdiagnosed patients did not suffer adverse consequences,except 4 patients were dead and 1 patient undertook unnecessary extended operation.Lack of specificity in clinical manifestations,lack of awareness of the disease,diversity of imaging performance and complications covering the original disease were the most common reasons of misdiagnosis.Postoperative pathological examination(83.77%),intraoperative findings(13.42%)and computed tomography angiography(2.16%)were the main means of definite diagnosis in misdiagnosed cases. ConclusionPulmonary sequestration is lack of specificity in clinical manifestations and easy to be misdiagnosed.Imaging showing the abnormal blood supply vessels is the key to the diagnosis.Improving the awareness of it can reduce misdiagnosis and incorrect treatment.
ObjectiveTo explore whether preoperative coronary angiography could increase the incidence of postoperative acute kidney injury for patients with valve replacement. MethodsA total of 638 patients underwent routine cardiac valve replacement in our hospital from January 2013 through September 2015. There were 118 patients with preoperative coronary angiography (a coronary angiography group), and 520 patients without coronary angiography (a non-coronary angiography group). Serum creatinine (Scr), urea nitrogen(Bun), brain natriuretic peptide (BNP), creatine kinase myocardial band (CK-MB), cardiac troponin I (cTnI) values were recorded at 4 time points:before surgery (T0), after surgery 12 h (T1), 24 h (T2), 48 h (T3). The number of patients with acute kidney injury at the time of 48 hours after surgery was recorded. ResultsScr values (91.6±37.7 μmol/L vs. 81.0±27.4 μmol/L, 84.9±23.6 μmol/L vs. 73.5±25.3 μmol/L) increased in the patients who did not undergo coronary angiography at the time of 24 hours and 48 hours after cardiac surgery compared with the patients with coronary angiography with statistical differences. While there was no statistical difference in the incidence of acute kidney injury between the two groups. The cardiac enzymes had no statistical difference between the two groups. ConclusionPreoperative coronary angiography does not increase the probability of postoperative acute kidney injury.
Coronary angiography (CAG) as a typical imaging modality for the diagnosis of coronary diseases hasbeen widely employed in clinical practices. For CAG-based computer-aided diagnosis systems, accurate vessel segmentation plays a fundamental role. However, patients with bradycardia usually have a pacemaker which frequently interferes the vessel segmentation. In this case, the segmentation of vessels will be hard. To mitigate interferences of pacemakers and then extract main vessels more effectively in CAG images, we propose an approach. At first, a pseudo CAG (pCAG) image is generated through a part of a CAG sequence, in which the pacemaker exists. Then, a local feature descriptor is employed to register the relative location of pacemaker between the pCAG image and the target CAG image. Finally, combining the registration result and segmentation results of main vessels and pacemaker, interferences of pacemaker are removed and the segmentation of main vessels is improved. The proposed method is evaluated based on 11 CAG images with pacemakers acquired in clinical practices. An optimization ratio of the Dice coefficient is 12.04%, which demonstrates that our method can remove overlapping pacemakers and achieve the improvement of main vessel segmentation in CAG images.Our method can further become a helpful component in a CAG-based computer-aided diagnosis system, improving its diagnosis accuracy and efficiency.
目的：了解有症状冠状动脉异常患者的临床特点和预后。方法：搜集1999年11月~2005年10月期间，因胸痛在心导管室行冠状动脉造影的病例，分析冠状动脉异常患者所占构成比，对该类患者进行随访，分析其临床特点及临床终点事件(死亡、心脏猝死、心肌梗死以及血运重建等)的发生情况。结果：在研究期间，共2003例胸痛患者进行了冠状动脉造影，74例患者有冠状动脉异常(构成比3.7%)，包括心肌桥54例、冠状动脉瘘16例、冠状动脉异常起源3例、单支冠状动脉1例。其中23名冠状动脉异常患者伴发有严重的冠状动脉粥样硬化病变或主动脉瓣病变。对无上述伴发疾病的冠状动脉异常患者进行随访，在随访期内(平均随访40月)，与冠状动脉正常患者相比，该类患者临床终点事件发生率无差异。结论：在有胸痛症状行冠状动脉造影的患者中，冠状动脉异常的构成比较低。该类患者的临床预后近似于冠状动脉正常患者。
ObjectiveTo investigate the safety and effectiveness of the multi-artery graf tstrategy for coronary bypass (MICS-CABG) with small incision in the left chest, and to provide experience for the promotion of this technique.MethodsThe clinical data of 64 patients with MICS-CABG in Department of Cardiac Surgery of Peking University Third Hospital from December 2015 to November 2019 were retrospectively analyzed. There were 54 males and 10 females, aged 36-77 (61.1±8.7) years. The left lateral thoracic incision (5-8 cm) was made through the 5th intercostal incision, and the operation was performed under off-pump CABG. With the help of the chest wall suspension device and the heart fixator, the proximal anastomosis of the ascending aorta, anastomosis of the target vessels of the left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA) systems were completed. The number of grafts was 2-4 (2.3±0.5) including 2 grafts in 45 patients, 3 grafts in 17 patients and 4 grafts in 2 patients. Three patients were treated with percutaneous intervention (PCI) hybridization and 62 patients were treated with total artery bypass graft. Coronary angiography was performed within 7 days after the operation to evaluate the graft patency rate. The incidence of major adverse cardiac and cerebrovascular events (MACCE) was recorded in the follow-up. The MACCE rate was calculated by Kaplan-Meier method.ResultsNone of the patients was transferred to thoracotomy and no intra-aortic balloon counterpulsation (IABP) or extracorporeal membrane oxygenation (ECMO) was used during the operation. Incision infection was in 1 patient and reoperation in 2 patients (all were postoperative hemorrhage). Within 30 days after surgery, MACCE occurred in 1 patient, including 1 patient of non-fatal myocardial infarction. The overall patency rate of angiography bypass was 96.2%, and the patency rate of anterior descending branch bypass was 98.2%. Follow-up was performed from 12 to 60 months (median follow-up time was 28 months). The loss rate was 7.8% (5/64). The incidence of MACCE was 84.9% (95%CI 79.5%-90.3%).ConclusionThe MICS-CABG can achieve completed re-vascularization and totally artery-CABG and the short-term and medium-term clinical results of the operation are good.