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心肌缺血最常见的原因是冠状动脉粥样硬化。另外,冠状动脉灌注不足、心肌本身病变等也是导致心肌缺血的常见原因。近年来,有报道发现肺动脉高压致肺动脉干扩张压迫冠状动脉左主干也可致心绞痛、心肌梗死等心肌缺血事件发生。可见,肺动脉干扩张压迫左主干也是导致心肌缺血的一个少见病因。据报道,肺动脉干扩张压迫左主干常常合并先天性心脏病或/和原发性肺动脉高压,其病死率较高。因此,认识本病的病理生理学机制及影像学征象,并选择适宜的治疗方法尤为重要。现从其发生的解剖基础、病理生理学机制及临床表现等几个方面对其进行描述,并阐述了多种影像学检查方法在诊断此病中的价值,进一步探讨了对此类疾病的干预措施。冠状动脉计算机断层扫描血管成像能更好的展现冠状动脉及其周围的异常结构,对本病有较高的确诊价值。对于本病的治疗,主要包括冠状动脉搭桥、经皮冠状动脉介入治疗及心肺移植术,虽然最优的治疗方法仍无定论,但经皮冠状动脉介入治疗是近年来认为安全、有效、可行的治疗方法。
The most common cause of myocardial ischemia is coronary atherosclerosis. In addition, inadequate coronary perfusion, myocardial disease itself is also a common cause of myocardial ischemia. In recent years, it has been reported that pulmonary hypertension caused by pulmonary artery expansion of the left coronary artery can also cause angina pectoris, myocardial infarction and other myocardial ischemic events. Can be seen that the expansion of pulmonary artery pressure left main trunk is also a leading cause of myocardial ischemia. It is reported that the expansion of pulmonary artery pressure left main trunk often complicated by congenital heart disease or / and primary pulmonary hypertension, the higher mortality. Therefore, to understand the pathophysiology of this disease and imaging signs, and select the appropriate treatment is particularly important. It is described from the anatomical basis, pathophysiological mechanism and clinical manifestations, and describes the value of a variety of imaging methods in the diagnosis of the disease, to further explore the intervention of such diseases . Coronary computed tomography angiography can better display the abnormal structure of the coronary artery and its surroundings, which has a higher diagnostic value for this disease. For the treatment of this disease, including coronary artery bypass grafting, percutaneous coronary intervention and cardiopulmonary transplantation, although the optimal treatment is still inconclusive, but in recent years, percutaneous coronary intervention is considered safe, effective and feasible treatment method.