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。
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。
Objective To investigate the clinical characteristics and treatment for Type II pulmonary vascular anomaly ( pulmonary arteriovenous malformations) of hepatopulmonary syndrome ( HPS)presenting with hemothorax. Methods A case of Type II pulmonary vascular anomaly of HPS presenting with recurrent hemothorax was described. The clinical data was analyzed and the related literature was reviewed. Results A 72-year-old male patient with Type II pulmonary vascular dilatations of HPS was described to present with recurrent dyspnea and encapsulated pleural effusions. After 4 procedures of thoracentesis, a total of 2510 mL of bloody pleural effusions was drained. The routine analysis of pleural fluid showed the count of red cells exceeded 100 ×109 / L, whereas cytologic examination and tumor biomarkers were negative. Then CTPA and pulmonary angiogramrevealed a Type II pulmonary vascular anomaly of HPS combined with hemothorax. The PaO2 of arterial blood in upright and supine position was 58. 3 mm Hg and 66. 3 mm Hg, respectively. Hypoxemia was alleviated and hemothorax was controlled after embolization of malformed blood vessels. Fromliterature review, similar cases of hemothorax resulted fromrupture of Type II pulmonary vascular anomaly of HPS were not reported. The primary clinical manifestations of HPS were dyspnea and cyanosis. Orthodeoxia and platypnea were most consistent with HPS. The best screening tool for hypoxemia in patients with HPS was P( A-a) O2. The characteristic findings of HPS on chest CT was a lesion or reticulonodular opacities occurring predominantly in the bases of the lungs, which could be enhanced by contrast medium. Pulmonary angiogram was necessary to identify the types of pulmonary vascular dilatations. Hepoxemia of patients with Type II HPS often responded poorly to oxygen therapy, whereas embolization of the pulmonary arteriovenous fistulas was helpful to improve anoxia. Conclusions Rupture ofType II pulmonary vascular malformations in HPS was a rare cause of hemothorax. Thrombosis of pulmonary arteriovenous malformations may result in significant improvement in oxygen saturations as well as control of hemothorax. In the setting of liver disease, intrapulmonary vascular dilatations and hypoxemia often suggestthe existence of HPS.
目的:通过对64排螺旋CT(MSCT)冠状动脉造影与选择性冠状动脉造影检测冠状动脉病变(冠状动脉狭窄≥50%)的对比分析,探讨64层螺旋CT评估冠状动脉病变诊断的准确性。方法:回顾性收集2007年12月~2008年10月于我院同期接受64层螺旋CT冠状动脉成像和常规经皮冠脉造影的112位冠心病患者的影像资料,以常规冠脉造影为参考标准,对2种检查方法的结果进行对比分析,评估64层螺旋CT冠脉造影对冠状动脉病变诊断的准确性。结果:按常规冠脉造影计算,112例患者共发现374处病变用于评价,MSCT造影检测冠脉病变总的准确性为906％,假阳性率和假阴性率分别为43％和51％;其中MSCT检测为假阴性均发生在左回旋支和右冠远段,假阳性均为冠状动脉伴有钙化。结论:64排螺CT冠状动脉造影检测冠状动脉病变诊断的准确性较高,但血管解剖和冠状动脉钙化可能会影响其对冠状动脉病变的评价和检测。
ObjectivesTo systematically review the efficacy and safety of intravascular ultrasound (IVUS) and coronary angiography-guided percutaneous coronary intervention (PCI) in left main coronary artery disease. MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) and cohort studies on the efficacy and safety of IVUS and coronary angiography-guided PCI in left main coronary artery disease from inception to March, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies; then, meta-analysis was performed using RevMan 5.3 software.ResultsA total of 7 studies involving 7 777 patients were included. The results of meta-analysis showed that: compared with PCI guided by coronary angiography, the incidence of cardiac death (OR=0.45, 95%CI 0.34 to 0.61, P<0.000 01), myocardial infarction (OR=0.67, 95%CI 0.53 to 0.84, P=0.004), major adverse cardiovascular events (OR=0.46, 95%CI 0.34 to 0.61, P<0.000 01), total deaths (OR=0.54, 95%CI 0.44 to 0.67, P<0.000 01), and in-stent thrombosis (OR=0.28, 95%CI 0.18 to 0.45, P<0.000 01) occurred in PCI guided by IVUS were lower. The differences were statistically significant. However, there were no statistical significance in the incidence of target revascularization in PCI (OR=0.80, 95%CI 0.40 to 1.61, P=0.54) and revascularization of target lesions (OR=0.68, 95%CI 0.36 to 1.27, P=0.23) between two groups.ConclusionsCurrent evidence shows that the IVUS-guided PCI can decrease the incidence of cardiac death, myocardial infarction, MACEs, stent thrombosis, total death and has no effect on target lesion revascularization and target vessel revascularization. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.
Objective To compare the bronchial arteriography through multidetector-row CT (MDCT) with the digital subtraction angiography (DSA) via femoral artery, and evaluate the application value of bronchial arteriography through MDCT in the diagnosis and treatment of hemoptysis. Methods 133 cases complained of hemoptysis were examined by MDCT and DSA via femoral artery respectively to perform bronchial arteriography, and the differences of image results by two methods were compared. Results 129 cases with abnormal bronchial arteries were confirmed by DSA via femoral artery, 117 cases were checked by MDCT [ the positive rate was 90.7% (117/129 ) ] . 117 cases with abnormal bronchial arteries were confirmed by both MDCT and DSA via femoral artery and 4 cases did not detected any abnormal arteries by both methods. The coincidence rate of two methods was 91.0% (121 /133) . MDCT and DSA via femoral artery showed the similar origins of abnormal bronchial arteries. The coincidence rate of two methods was 100% . Conclusions There is a high coincidence rate betweenMDCT and DSA in detecting bronchial artery abnormalities. MDCT shows the origins of abnormal vessels clearly which could be a fist-choice of routine imagination for interventive operation.
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.