戴汝平
中国医学科学院阜外医院 心血管内科
BACKGROUND:To evaluate the role of CT angiography (CTA) in the diagnosis and subcategorization of unroofed coronary sinus syndrome (URCS).METHODS:We retrospectively analyzed 46 URCS patients diagnosed by CTA. Based on the defect location and size of coronary sinus (CS), URCS was divided into four types: complete defect as type I, partial defect of proximal CS as type II, partial defect of distal CS as type III, partial defect in which a communication occurs between CS and left atrial as type IV. According to presence of left superior vena cava (LSVC), all types were divided into 2 subtypes as a and b. All 46 patients underwent echocardiography.RESULTS:According to subcategorization of URCS by CTA, type I was observed in 23 cases (Ia 7, Ib 16), type II in 10 cases (IIa 3, IIb 7), type III in 12 cases (IIIa 3, IIIb 9), and type IV in 1 case classified as IVb subtype. In these 46 cases, 21 were detected by echocardiography as URCS (46%). The sensitivity of echocardiography in detecting URCS was significantly lower compared with cardiac CTA (P<0.05). In type I patients, the mean CS diameter indexed to body surface area (CS index) was larger than other types (P<0.05). Thirty patients were successfully treated by surgery and the diagnosis of URCS was confirmed by operative findings. Among them, data were available in 22 cases for analysis; and patients with types I, II and IIIa differ significantly from those with types IIIb and IV (P<0.05) with respect to surgical repair.CONCLUSIONS:CTA and imaging reconstruction can provide excellent anatomical delineation of the heart, great vessels, and CS, and allows for precise diagnosis of URCS. This CTA classification scheme of URCS is simple and easy to use, and has important clinical implications for diagnosis and treatment.
Journal of thoracic disease 2017
OBJECTIVE:To explore impact of coronary CT angiography findings on preventive medical treatment and control of coronary artery disease (CAD) risk factors.METHODS:Consecutive patients with atherosclerotic plaque detected by coronary CT angiography were enrolled in our study from September 2013 to December 2014, grouped as <50% stenosis and ≥ 50% stenosis.Baseline and follow-up data were recorded.Comparative analysis was performed both between stenosis groups and pre- and post-CT angiography data.Multivariable Logistic regression were preformed to investigate association between coronary CT angiography findings and subsequent medical therapies.RESULTS:Totally 160 patients were enrolled in our study, 99 were <50% stenosis and 61 were ≥ 50% stenosis.Significant reduction of total cholesterol (5.06 ± 1.04 vs 4.54 ± 1.09 mmol/L, P<0.01), low-density lipoprotein cholesterol (3.16 ± 0.95 vs 2.60 ± 0.88 mmol/L, P<0.01), and triglyceride (1.66 (1.14, 2.28) vs 1.55(1.07, 2.05) mmol/L, P=0.004) were observed Pre- versus post-CT angiography. Compared to patients with <50% stenosis, patients with ≥ 50% stenosis demonstrated more significant reduction with regard to total cholesterol (-0.70 ± 0.94 vs -0.42 ± 0.96 mmol/L, P=0.035) and low-density lipoprotein cholesterol (-0.78 ± 0.99 vs -0.43 ± 0.79 mmol/L, P=0.016). After CT angiography, aspirin (13.8% vs 65.6%, P<0.01) and statin (20.0% vs 71.9%, P<0.01) use were significantly increased, blood pressure medication (53.1% vs 63.1%, P=0.07) use showed no statistical differences. Adjusted for baseline risk factors and pretest medications, CT angiography findings were independently associated with increased post-CT angiography use of aspirin (adjusted OR (95% CI) : 3.58 (1.61-7.99), P=0.002) and statin (adjusted OR (95% CI) : 15.01 (4.40-51.22), P<0.01).CONCLUSION:Coronary CT angiography findings demonstrated direct impact on subsequent medical therapies and control of CAD risk factors, and offered important guidance for prevention strategies of CAD.
Zhonghua yi xue za zhi 2015
PURPOSE:To compare coronary plaque burden, composition, distribution and the degree of coronary artery stenosis in invasive coronary angiography (ICA) diagnosed coronary artery disease (CAD) patients with or without metabolic syndrome (MetS).METHODS:From January 2008 to June 2011, consecutive patients underwent both coronary computed tomography angiography (CCTA) and ICA within three months were enrolled. Patients with history of previous percutaneous coronary interventions (PCI) and coronary artery bypass grafting (CABG) were excluded. Plaque characteristics and maximal luminal diameter stenosis were analyzed on a 16-segment basis as suggested by the American Heart Association classification.RESULTS:The study population consisted of 872 patients [age (60.2 ± 10.0) years, 72.70% males] including 377 patients with MetS and 495 patients without MetS. The median coronary artery calcium score (CACS) was higher in MetS patients than in non-MetS patients [102 (10, 410) vs. 58 (0, 274) , P < 0.01]. Percentage of patients with no coronary artery calcium was significantly lower in MetS group than in non-MetS group [19.63% (74/377) vs. 30.71% (152/495) , P < 0.01], while percentage of patients with severe coronary calcium (CACS ≥ 1000) were significantly higher in MetS than non-MetS group [8.22% (31/377) vs. 4.65% (23/495) , P = 0.03]. The proportion of patients with 1-vessel disease was lower [23.61% (89/377) vs. 36.77% (182/495), P < 0.01], 2-vessel [29.71% (112/377) vs. 22.83% (113/495), P < 0.05] and 3-vessel disease [35.54% (134/377) vs. 24.44% (121/495) , P < 0.01] were higher in MetS group than in non-MetS group. Calcified plaque of LM and the middle and distal coronary artery were significantly higher in MetS group than in non-MetS group (all P < 0.05) .CONCLUSIONS:CAD patients with MetS are associated with severer coronary artery calcium deposition and higher percentage of calcified plaque in the middle and distal coronary arteries and severer obstructive coronary vessels.
Zhonghua xin xue guan bing za zhi 2013
OBJECTIVE:To analyze the incidence and cause of complications during and after interventional therapy for congenital heart disease (CHD).METHODS:From April 1986 to April 2009, 388 out of 6029 patients with CHD developed complications during and post interventional therapy, another 5 patients died post procedure, clinical data from these 393 patients were retrospectively analyzed. The patients with severe functional insufficiency requiring intervention or surgery during and after interventional therapy were classified as severe complications.RESULTS:The overall complication rate was 6.44% [7.69% post atrial septal defect occlusion, 4.20% post patent ductus arteriosus (PDA) occlusion, 1.31% post percutaneous balloon pulmonary valvuloplasty, 14.94% post ventricular septal defect occlusion, 3.13% post percutaneous closure of aortopulmonary collaterals, 30.95% post catheter embolotherapy of pulmonary arteriovenous malformations, 12.50% post transcatheter closure of coronary artery fistulae, 20.00% post transcatheter closure of ruptured sinus of Valsava aneurysm, 66.67% post percutaneous balloon aortic valvuloplasty]. The severe complication rate was 0.65%(39/6029). The procedure-related mortality rate was 0.08% (5/6029), 0.26% (2/761) post percutaneous balloon pulmonary valvuloplasty, 0.05% (1/2070) post PDA occlusion, 9.10% (1/11) post balloon atrial septostomy, 33.33% (1/3) post percutaneous balloon aortic valvuloplasty. Emergency Cardiovascular surgery rate was 0.22% (13/6029). Selective surgery was required in 0.13% (8/6029) of patients post procedure. Two patients (0.03%) received permanent pacemaker implantation.CONCLUSIONS:The severe complications and mortality rate of interventional therapy for CHD are relative low. Post procedure follow-up is needed fro monitoring possible procedure-related complications.
Zhonghua xin xue guan bing za zhi 2009
OBJECTIVE:In this study, we attempted to observe the prevalence and risk factors of atrial tachyarrhythmias (AT) before and after transcatheter closure of atrial septal defect (ASD).METHODS:264 adult patients aged over 40 years (67 men and 197 women) who underwent transcatheter closure of ASD between September, 1997 and December, 2005 were included in this study. Incidence of preoperative and postoperative AT was analyzed, risk factors for AT were determined with multivariate stepwise logistic regression analysis.RESULTS:Incidence of AT before closure was 9.1% (24/264). Twenty-nine patients (11.0 percent) developed AT after transcatheter closure (24 atrial fibrillation, 1 paroxysmal flutter, 4 paroxysmal atrial arrhythmia). The prevalence in patients of 40 to 49 years, 50 to 59 years and above 60 years was 4.3%, 14.6% and 26.3%, respectively. Most patients with atrial fibrillation were symptomatic. Compared to patients without AT, patients developed AT after closure were significantly older (53.0 +/- 7.6 years vs. 47.8 +/- 6.6 years, P < 0.01) and had larger defects (23.5 +/- 5.7 mm vs. 21.3 +/- 5.2 mm, P > 0.05), higher systolic pulmonary pressure (38.4 +/- 13.1 vs. 34.1 +/- 10.1, P < 0.05), larger left atrium dimension [(38.0 +/- 3.9) mm Hg (1 mm Hg = 0.133 kPa) vs. (33.6 +/- 4.4) mm Hg, P < 0.01], larger end diastolic right ventricular dimension [(34.7 +/- 5.9) mm vs. (32.1 +/- 6.8) mm, P > 0.05], higher incidence of tricuspid regurgitation (96.6% vs. 75.3%, P = 0.01), higher incidence of preoperative AT (51.7% vs. 3.8%, P < 0.01) and higher incidence of hypertension (27.6% vs. 10.2%, P = 0.013). Multivariate analysis showed that older age [odds ratio (OR) 2.659, 95 percent confidence interval (CI) 1.080 to 6.547, P < 0.05], presence of preoperative AT (OR 54.311, CI 9.819 to 300.395, P < 0.01), and left atrial enlargement (OR 8.529 per 10 mm increment, CI 2.162 to 33.643, P < 0.01) were independent predictors of AT after closure.CONCLUSIONS:Incidence of AT was similar before and after percutaneous closure in patients with atrial septal defects aged 40 years and over. The risk of AT is related to the age at the time of transcatheter closure, the presence of preoperative AT and enlarged left atria.
Zhonghua xin xue guan bing za zhi 2007
OBJECTIVE:To evaluate the evolution of medically treated atherosclerotic aortic ulcers by computed tomography (CT).METHODS:Thirty-five patients (31 men and 4 women, aged from 40 to 79 years, mean 56.2 +/- 10.8 years) with known aortic ulcers were monitored by CT (follow up time 7 - 730 days, mean 135 days), 80 - 100 ml contrast media (Ultravist 300 or 320, or Omnipaque 300 or 320 mg/ml) was injected with a rate of 3.5 - 4.5 ml/s. The scan delayed time was 18 - 30 s. Ulcers dimensions were measured according to maximum depth, maximum length and maximum width.RESULTS:Thirty-one patients with intramural hematomas and 1 patient with atherosclerotic aortic arch aneurysm without intramural hematoma were medically treated and another 3 patients were surgically treated. Intramural hematoma regression was monitored in 31 medically treated patients with intramural hematomas. CT was repeated at 2 weeks, 3 and 6 months. Intramural hematoma resolved gradually during follow up [thickness: (7.69 +/- 4.24) mm at 3 months, (3.06 +/- 1.67) mm at 6 months, P < 0.05 vs. 1st CT: (11.96 +/- 4.16) mm while ulcer maximum depth (11.17 +/- 6.03) mm at 3 months, (11.35 +/- 5.59) mm at 6 months, P < 0.05 vs. 1st CT: (7.36 +/- 6.61) mm, maximum width (14.40 +/- 6.35) mm at 3 months, (18.55 +/- 10.94) mm at 6 months, P < 0.05 vs. 1st CT: (7.15 +/- 6.39) mm, maximum length (17.12 +/- 7.15) mm at 3 months, (18.13 +/- 10.89) mm at 6 months, P < 0.05 vs. 1st CT: (11.64 +/- 10.06) mm increased progressively during follow-up].CONCLUSION:CT was a useful tool for deflecting atherosclerotic aortic ulcers and monitoring therapeutic effects.
Zhonghua xin xue guan bing za zhi 2006
OBJECTIVE:To study the morphological features of secundum atrial septal defect (ASD) in adult and the implications for transcatheter closure.METHODS:Transcatheter closure using Amplatzer duct occluder was performed in 272 adult patients with ASD from September 1997 to December 2005. The morphological features were evaluated by transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE). The size, length and thickness of rims, occluder diameter, the complete closure rate, residual shunt rate and complications were compared in patients with deficient and/or thin rims (Group A, n = 135) and patients with well-developed rims (Group B, n = 137).RESULTS:The complete closure rate was 97.8% (132/135) in group A and 99.3% (136/137) in group B. There were 74 cases with deficient rims, 39 cases with thin rims and 22 cases with both deficient and thin rims in group A. Gender distribution, age, operation successful rate, residual shunt rate and complication rate were similar between the 2 groups. The defect diameters measured by TTE (18.9 +/- 5.5 mm vs. 16.5 +/- 4.8 mm, P < 0.01), TEE (22.7 +/- 5.0 mm vs. 20.0 +/- 5.5 mm, P < 0.01) and occluder diameters used (29.1 +/- 5.7 mm vs. 26.0 +/- 5.9 mm, P < 0.01) were significantly larger in groups A than that in group B. The systolic pulmonary artery pressure was also significantly higher in groups A than that in groups B (36.9 +/- 11.9 mm Hg vs. 32.6 +/- 9.1 mm Hg, P < 0.01). There are significant correlations between occluder diameters and defects measured by either TTE or TEE in both groups (group A, TTE: r = 0.709, TEE: r = 0.850; group B, TTE: r = 0.716, TEE: r = 0.915, P all < 0.01).CONCLUSIONS:Poor residual rims were found in around 50% of adult patients with ASD. Transcatheter closure of these defects could be successfully performed with larger occluders. The defect diameters measured by TTE and TEE, especially the latter, could guide the occluder selection.
Zhonghua xin xue guan bing za zhi 2006
