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患者男性,76岁,1986年以来出现典型的心绞痛症状并进行性加重。1989年9月发生非透壁性前壁心肌梗塞,4周后入院。心电图示:V2-V4导联呈QS型,S-T段抬高,提示透壁性的壁心梗伴室壁瘤形成。经消心痛(120mg)和心痛定(10mg,每日3次)等抗心绞痛治疗,心绞痛仍长时间持续发作,后施行了冠脉造影和左室造影术。冠脉造影示左前降支冠状动脉几乎完全性闭塞,左回旋支亦有病变但较轻,极少侧支循环,左室造影示前壁收缩功能明显障碍(室壁瘤形成)。因左前降支高度狭窄引起的胸痛症状不能缓解,梗塞后8周对左前降支(RIVA)施行了球囊扩张术。扩张后狭窄部明显增宽,残余狭
The patient was a man, 76 years old, who had developed symptoms of angina since 1986 and had progressively worsened. A non-transmural anterior myocardial infarction occurred in September 1989 and was admitted 4 weeks later. Electrocardiograms show that the V2-V4 lead is QS-type, S-T segment elevation, suggesting that the transmural wall infarction with ventricular aneurysm formation. After angina pectoris treatment (120 mg) and nifedipine (10 mg, 3 times daily), angina pectoris continued to occur for a long time, followed by coronary angiography and left ventricular angiography. Coronary angiography showed that the left anterior descending coronary artery was almost completely occluded, and the left circumflex branch had lesions but was mild, with little collateral circulation, and left ventricular angiography showed significant dysfunction of the anterior wall systolic function (formation of aneurysm). Symptoms of chest pain caused by the narrowing of the left anterior descending coronary artery cannot be relieved. The left anterior descending artery (RIVA) was subjected to balloon dilation 8 weeks after the infarction. After the expansion, the stricture is obviously widened and the remaining narrow