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目的 分析孤立性回旋支病变的临床、介入治疗及预后特点。方法 6 3例确诊心绞痛或心肌梗死的患者为本院 2 0 0 0年 1月至 2 0 0 2年 12月收入院 ,并接受冠状动脉造影及介入治疗的病例。其中心肌梗死 36例 ,最小年龄 37岁 ,最大年龄 74岁 ,平均年龄 (5 7± 11)岁 ,男性 5 5例 ,女性 8例。 5 3例患者完成随访。结果 (1)冠脉及左心室造影 :6 3例患者共有 6 7处明显狭窄病变 ,近段狭窄 14处 ,中段狭窄 36处 ,远段狭窄 7处 ,钝缘支狭窄 10处 ,其中 11处狭窄为完全闭塞 ,15处狭窄为次全闭塞 (95 %～ 99% )。左心室功能正常者 34例 (5 4 % ) ,异常者 2 9例(46 % ) ,但平均EF正常 (71%± 12 % )。 (2 )心电图特征 :在回旋支病变所导致的Q波或非Q波心肌梗死患者中 ,病理性Q波及ST T异常最常出现在下后壁及下壁。在下后壁、前侧壁及高侧壁梗死患者中 ,以回旋支中段狭窄或闭塞最常见。 (3)介入治疗 :6 3例患者均成功置入支架 ,B型病变 (74 % )明显多于A、C型病变。平均支架直径 (3.12±0 .4 2 )mm ,平均支架长度 (15 .8± 4 .14 )mm。住院期间无并发症发生。 (4)随访 :随访时间 12～ 35个月 ,平均随访(2 0 .8± 5 .0 )个月。造影随访 6例均无再狭窄。 1例猝死 (1.9% ) ,2例发生非致死性心肌梗死 ,3例术后心绞?
Objective To analyze the clinical features, interventional treatment and prognosis of solitary myofibrous lesions. Methods Sixty-three patients with angina pectoris or myocardial infarction were admitted to our hospital from January 2000 to December 2002 and underwent coronary angiography and interventional therapy. 36 cases of myocardial infarction, the minimum age of 37 years old, the maximum age of 74 years, mean age (57 ± 11) years, 55 males and 8 females. 5 3 patients completed the follow-up. Results (1) Coronary angiography and left ventricular angiography: Sixty-three patients with obvious stenosis were included in the 63 cases, including 14 proximal stenosis, 36 middle stenosis, 7 distal stenosis, 10 obturator margin stenosis, of which 11 Stenosis was complete occlusion, 15 stenosis subtotal occlusion (95% to 99%). 34 cases (54%) had normal left ventricular function and 29 cases (46%) had abnormalities, but the average EF was normal (71% ± 12%). (2) Electrocardiogram characteristics: Pathological Q waves and ST T abnormalities are most often found in the posterior wall and inferior wall in patients with Q wave or non-Q wave myocardial infarction caused by circumflex bronchial lesions. In the lower posterior wall, anterior wall and high-sidewall infarction patients, the medial mastoid stenosis or occlusion is the most common. (3) Interventional therapy: all 63 patients were successfully placed in the stent, type B lesions (74%) were significantly more than those of type A and C lesions. The average stent diameter (3.12 ± 0.42) mm, the average stent length (15 .8 ± 4.14) mm. No complications during hospitalization. (4) Follow-up: The follow-up time ranged from 12 to 35 months, with a mean follow-up of (20.8 ± 5.0) months. Follow-up 6 cases no restenosis. 1 case of sudden death (1.9%), 2 cases of non-fatal myocardial infarction, and 3 cases of postoperative cardiac arrest?