Exploring risk factors for combined coronary microvascular dysfunction in patients with ischemia and non-obstructive coronary artery disease / 中华核医学与分子影像杂志

Objective:To investigate the risk factors for combined coronary microvascular dysfunction (CMD) in patients with ischemia and non-obstructive coronary artery disease (INOCA).Methods:From October 2020 to May 2022, 100 INOCA patients with myocardial ischemic symptoms who underwent coronary angiography (CAG) suggestive of <50% stenosis in all three coronary arteries at the Tenth People′s Hospital of Tongji University were prospectively recruited. Myocardial perfusion imaging (MPI), transthoracic echocardiography and cadmium-zinc-telluride (CZT) SPECT coronary flow quantification were performed in the same month, and 93 INOCA patients (36 males and 57 females, age (63.0±10.9) years) were finally included. CMD was defined as coronary flow reserve (CFR)<2.5. Independent-sample t test, Mann-Whitney U test and χ2 test were used to compare MPI results and left ventricular volume parameters between CMD and non-CMD groups. ROC curve analysis was used to analyze the efficacy of each index in predicting CMD, and independent risk factors for CMD were screened by multivariate logistic regression analysis. Results:Among 93 INOCA patients, 29 were in the CMD group and 64 were in the non-CMD group. The age, proportion of hypertension, left ventricular mass index (LVMI), summed stress score (SSS), summed difference score (SDS), left ventricular internal diameter systolic (LVIDS), interventricular septum thickness (IVST), and left ventricular posterior wall thickness (LVPWT) in the CMD group were higher than those in the non-CMD group ( t values: 2.42-3.76, χ2=8.94, z values: -3.31, -3.41, all P<0.05). ROC curve analysis showed that LVMI, SSS, SDS, LVPWT, IVST and age were significant in predicting CMD (AUCs: 0.67-0.72). Multivariate logistic regression analysis showed that LVMI (odds ratio ( OR)=1.08, 95% CI: 1.01-1.17), SDS ( OR=5.37, 95% CI: 1.95-14.78), hypertension ( OR=5.68, 95% CI: 1.34-24.18) and age ( OR=1.10, 95% CI: 1.03-1.18) were risk factors for CMD. Conclusion:LVMI, SDS, hypertension and age are strongly associated with combined CMD in INOCA patients, which can be used for early risk stratification of INOCA patients.

Research Progress of Coronary Physiological Evaluation Development in 2021 / 医用生物力学

Cardiovascular disease is one of the most serious diseases endangering human life and health. In China, 2 out of every 5 people die of cardiovascular diseases. Myocardial ischemia is one of the important cardiovascular diseases. Fractional flow reserve (FFR) is used to quantify myocardial ischemia in epicardial stenoses. Index of microvascular resistance (IMR) is an invasive index for quantitative evaluation of coronary microcirculation. Traditional FFR and IMR measurements rely on guide wires to perform interventional measurements under the maximum hyperemia state,so as to assist the diagnosis of myocardial ischemia clinically. Coronary angiography-derived FFR and IMR without using invasive pressure-wire measurement, hyperemic stimulus and contraindications can assist the diagnosis and treatment of percutaneous coronary intervention by fast simultaneous calculation of FFR and IMR. In this review, the research progress of coronary angiography-derived FFR and IMR as well as other coronary physiological evaluation in recent years were summarized. It is of great clinical value to further study the combination of coronary angiography-derived FFR and IMR in functional research of coronary circulation from macro to micro.

Avaliação da Circulação Coronariana após a Cirurgia de Jatene / Evaluation of Coronary Circulation after Arterial Switch Operation

Resumo Fundamento A avaliação da artéria coronária após a cirurgia de Jatene ainda é um desafio clínico. Objetivo Correlacionar alterações anatômicas identificadas por tomografia computadorizada cardíaca (TCC) com alterações fisiológicas detectadas na avaliação clínica para diagnosticar obstrução coronária no pós-operatório tardio de pacientes submetidos à cirurgia de Jatene. Métodos Este estudo incluiu 61 pacientes consecutivos com idade média de 9,4 anos que foram submetidos à cirurgia de Jatene. Os pacientes realizaram ecocardiografia, eletrocardiografia, teste cardiopulmonar do exercício, e tomografia computadorizada cardíaca para avaliação da capacidade funcional e anatomia da artéria coronária. Resultados A tomografia computadorizada cardíaca revelou que somente 3,3% dos pacientes apresentaram estenose da artéria coronária. Esses pacientes eram assintomáticos, e não foram detectados sinais de isquemia miocárdicas pelos exames realizados. Conclusão A incidência de anormalidades da artéria coronária é de 3,3% no seguimento tardio de nossa coorte de pacientes submetidos à cirurgia de Jatene. Não existe uma diretriz clara sobre o porquê, quando, e como esses pacientes deveriam ser rastreados, ou o que propor quando pacientes assintomáticos forem diagnosticados com obstrução coronária.

Abstract Background Coronary artery evaluation remains after arterial switch operation a clinical challenge. Objective This study aims to correlate anatomical changes diagnosed by cardiac computed tomography (CCT) with physiological alterations on clinical evaluation to diagnose coronary obstruction in late ASO patients. Methods This study included 61 consecutive patients with mean age of 9.4 years who underwent ASO. The patients were submitted to echocardiography, electrocardiography, cardiopulmonary exercise test, and cardiac computed tomography to evaluate functional capacity and coronary artery anatomy. Results Cardiac computed tomography revealed that only 3.3% of the patients had coronary stenosis. These patients were asymptomatic, and no signs of myocardial ischemia were detected by the tests. Conclusion The incidence of coronary abnormalities in late ASO patients was 3.3% in our cohort. There is no clear guideline as to why, when, and how these patients should be screened or what to propose when a coronary obstruction is diagnosed in asymptomatic patients.

Mechanisms and potential therapeutic targets for coronary collateral growth / 中华老年医学杂志

Induction of coronary collateral circulation, that is, therapeutic angiogenesis, is considered a promising treatment for coronary heart disease.However, coronary collateral growth is a complex process and is related to a variety of factors.Although it has achieved promising outcomes in animal experiments, clinical trials have so far failed to replicate these results.Further studies on the growth mechanisms of coronary collateral circulation are still needed before a feasible clinical treatment strategy becomes available.

Mechanisms and potential therapeutic targets for coronary collateral growth / 中华老年医学杂志

Induction of coronary collateral circulation,that is,therapeutic angiogenesis,is considered a promising treatment for coronary heart disease.However,coronary collateral growth is a complex process and is related to a variety of factors.Although it has achieved promising outcomes in animal experiments,clinical trials have so far failed to replicate these results.Further studies on the growth mechanisms of coronary collateral circulation are still needed before a feasible clinical treatment strategy becomes available.

Related risk factors of PET/CT detected coronary microvascular disease in patients with chest pain and no obstructive coronary artery disease / 中华心血管病杂志

Objective: To explore the related factors of the coronary microvascular disease (CMD) diagnosed with positron emission tomography(PET)/CT in patients with chest pain and without obstructive coronary artery disease (NOCA). Methods: This study was a single-center retrospective cross-sectional study. Consecutive patients with chest pain and NOCA on coronary angiography, who underwent PET/CT quantitative myocardial blood flow measurements at TEDA International Cardiovascular Hospital from August 2018 to January 2019, were enrolled for this study. The diagnostic criteria for NOCA was the absence of coronary artery diameter stenosis ≥50% on coronary angiography. Clinical data, global left ventricular myocardial blood flow on stress and rest, and the coronary flow reserve (CFR) were analyzed. Patients were divided into two groups according to CFR. Patients with CFR<2 were defined as CMD group, and the rest were classified as control group. Pearson correlation analysis and Logistics regression analysis were used for exploring the risk factors of the CMD. Results: A total of 66 patients, with an mean age of (56.7±9.6) years, were included in the study, including 41 females (62%). There were 20 patients with CMD (30%). Body mass index (BMI) was significantly higher in CND group than in control group ((28.1±3.6) kg/m2 vs. (25.6±3.5) kg/m2, P=0.01). Total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) were also significantly higher in CMD group than in control group ((4.89±1.03) mmol/L vs. (4.30±1.02) mmol/L and (3.23±0.81) mmol/L vs. (2.71±0.95) mmol/L respectively, P=0.038). Pearson correlation analysis showed that CFR was moderately correlated with BMI (r=-0.45, P<0.001), and was weakly correlated with TC and LDL-C (r=-0.271 and r=-0.280, respectively, P<0.05). Multivariate logistic regression analysis showed that BMI (the risk of CMD increased by 1.528 times for every 5 kg/m2 increase in BMI, 95%CI 1.083-5.897, P<0.05) was an independent risk factor of CMD after adjusted by gender, hypertension, diabetic mellites and LDL-C. Conclusion: For patients with NOCA and chest pain, high BMI is independent risk factor of CMD diagnosed by PET/CT.

New research progress of coronary microvascular dysfunction / 心血管康复医学杂志

Coronary microcirculation regulates coronary blood flow volume via systolic and diastolic function and af—fects myocardial perfusion ,which possesses deep influence on prognosis of patients with coronary heart disease and cardiomyopathy .Along with developments of recent noninvasive and invasive techniques , continuous updates of medication area ,understanding of coronary microvascular dysfunction keeps going deeper .The present article made following review on new research progress of coronary microvascular dysfunction .

The artery of Mouchet: blood supply of the septomarginal trabecula in 50 human hearts

SUMMARY The septomarginal trabecula is a muscular structure which transmits the right branch of the atrioventricular bundle. It is usually supplied by a branch from the second anterior septal artery. Anastomoses between the right and left coronary arteries may happen on the septomarginal trabecula. They are of great significance in order to prevent ischemia during a myocardial infarction. Surgeries such as Konno's and Ross' procedures implies in knowledge of these vessels anatomy. The coronary arteries of 50 human hearts were injected with latex and subsequentely dissected with the purpose of identifying the arterial branch that supplied the septomarginal trabecula. The trabecular branch arose from the second anterior septal artery in 38% of cases, and the branch arose from the first anterior septal artery in 26%. One of the hearts had its septomarginal trabecula supplied by the conus arteriosus arteryliterature. Anastomoses between the right and left coronary arteries were found inside the septomarginal trabecula. The right branch of the atrioventricular bundle is subject to a great number of clinical conditions and is often manipulated during surgery, thus, the study of the septal branches of the coronary arteries and the trabecular branch is essential.

RESUMO A trabécula septomarginal é uma estrutura muscular que transmite o ramo direito do feixe atrioventricular. É usualmente suprida por um ramo da segunda artéria septal anterior. Anastomoses entre as artérias coronárias direita e esquerda podem ocorrer na trabécula. São de grande significância especialmente na prevenção de isquemia durante um infarto do miocárdio. Procedimentos cirúrgicos como o de Konno's e Ross implicam conhecimento anatômico desses vasos. As artérias coronárias de 50 corações humanos foram injetadas com látex e dissecadas com o propósito de identificar o ramo arterial que supria a trabécula septomarginal. Em somente 38% dos casos o ramo foi proveniente da segunda artéria septal anterior, enquanto que em 26% dos casos a artéria se originou da primeira septal anterior. Um dos corações teve a trabécula septomarginal suprida por um ramo originário da artéria do cone arterioso. Além disso, foram encontradas anastomoses entre as artérias coronárias no interior da trabécula septomarginal. Em suma, o ramo direito do feixe atrioventricular está sujeito a inúmeras condições clínicas e é alvo de manuseio em cirurgias, logo, o estudo dos ramos septais das artérias coronárias, em especial o ramo trabecular é essencial.

Patterns of arterial vascularization in swine hearts / Padrões de vascularização arterial em corações de suínos

This study aimed to characterize the patterns of arterial vascularization in swine hearts. Ninety swine hearts were submitted to the Spalteholz diaphanization technique in order to dissect the coronary arteries. Three types of arterial vascularization patterns were characterized through the behaviorof the rami circumflexus and interventricularis, namely: balanced, right and left types. The balanced pattern was the most frequently (42.2%); in this case, the rami circumflexus and interventricularis occupied their respective sulci. The right type (40%) was further categorized into three vascularization subtypes. In the first, ramus circumflexus dexter branched from the ramus interventricularis subsinuosus. In the second, the arteria coronaria dextra branched from ramus interventricularis subsinuosus and ramus circumflexus. In the third model, arteria coronaria sinister branched from ramus interventricularis paraconalis. The left type (17.7%) exhibited two subtypes. In the first, ramus interventricularis paraconalis ran through the entire corresponding sulcus and the ventral third of sulcus interventricularis subsinuosus, and ramus interventricularis subsinuosus occupied the dorsal and middle third of its respective sulcus. In the second, ramus interventricularis subsinuosus branched from arteria coronaria dextra and ran through the dorsal and medium thirds of its respective sulcus, and the ventral third was occupied by the collateral branch of ramus circumflexus sinister. Our results reinforce the thesis that the blood distribution system through the coronary artery in swine is similar to human, not only in qualitative but also by a quantitative comparison.

Este estudo teve como objetivo caracterizar os padrões de vascularização arterial em corações de suínos. Para tanto, 90 corações de suínos foram submetidos à técnica de diafanização de Spalteholz com a finalidade de dissecar as artérias coronárias. Através do comportamento dos rami circumflexus e interventricularis caracterizou-se três modalidades de vascularização arterial do coração de suínos, sendo eles os tipos equilibrado, direito e esquerdo. O equilibrado foi observado com maior frequência (42,2%), neste caso os rami circumflexus e interventricularis das artérias coronárias ocupavam seus respectivos sulcos. O tipo direito (40%) apresentou três subtipos de vascularização. No primeiro o ramus circumflexus dexter ramificava-se formando o ramus interventricularis subsinuosus. No segundo, a arteria coronaria dextra emitia o ramus interventricularis subsinuosus e ramus circunflexus. E no terceiro modelo, da arteria coronaria sinistra emergia o ramus interventricularis paraconalis. O tipo esquerdo (17,7%) apresentou dois subtipos. No primeiro, o ramus interventricularis paraconalis percorria todo o sulco correspondente e o terço ventral do sulcus interventricularis subsinuosus, o ramus interventricularis subsinuosus ocupava os terços dorsal e médio do seu respectivo sulco. No segundo, o ramus interventricularis subsinuosus oriundo da arteria coronaria dextra percorria apenas os terços dorsal e médio do seu respectivo sulco, ficando o terço ventral ocupado por colateral do ramus circumflexus sinister. Nossos resultados reforçam a tese de que a distribuição do suprimento sanguíneo pela artéria coronária em suínos é semelhante ao humano, não apenas de maneira qualitativa, mas também do ponto de vista quantitativo.

Anomalías de las arterias coronarias / Coronary arteries abnormalities / As anormalidades das artérias coronárias

El dolor torácico no relacionado con trauma es una causa importante de consulta en los servicios de urgencias, con frecuencia alrededor del 10 %, y es secundario al síndrome coronario agudo. La mayoría de las veces está relacionado con la formación de un trombo por ulceración o ruptura de una placa aterosclerótica. En algunos casos es secundario a causas raras como las anomalías del origen de las arterias coronarias. Presentamos el caso de un paciente con origen anómalo del tronco de la arteria coronaria izquierda, que ingresó con cuadro clínico sugestivo de síndrome coronario agudo sin elevación del segmento ST. Se discuten sus principales aspectos, el significado clínico y las opciones terapéuticas.

Chest pain not related with injury is an important cause of visit to emergency departments; it accounts for 10 % of such visits and is caused by acute coronary syndrome. In most cases it is related to thrombus formation secondary to ulceration or rupture of an atherosclerotic plaque. Sometimes it is secondary to rare causes such as the presence of congenital coronary artery anomalies. We report the case of a patient with anomalous origin of the left main coronary artery, who was admitted to the hospital with a clinical picture suggestive of acute coronary syndrome without ST segment elevation. Its main aspects, clinical significance and therapeutic options are discussed.

das principais causas de consulta a serviços de emergência, muitas vezes em torno de 10 por cento e é secundária à síndrome coronariana aguda. A maior parte das vezes está relacionada com a formação de um trombo por ulceração ou ruptura de uma placa aterosclerótica. Em alguns casos, é secundária a causas raras como as anomalias da origem das artérias coronárias. Apresentamos o caso de um paciente com origem anômala da artéria coronária esquerda do tronco, que ingressou com um quadro clínico sugestivo de síndromes coronarianas agudas sem elevação do segmento ST . Se discutem os principais aspectos, o significado clínico e opções de tratamento.

Relationship Between Slow Coronary Flow and Coronary Microcirculatory Dysfunction in Relevant Patients / 中国循环杂志

Objective: To study the relationship between slow coronary lfow (SCF) and coronary microcirculatory dysfunction in relevant patients and to explore the risk factors for SCF development. Methods: Our research was conducted in 2 groups: SCF group, the patients with coronary angiography conifrmed diagnosis and Control group, the subjects with normal coronary lfow.n=32 in each group. The general information, blood levels of biochemical indicators, hs-CRP levels, TIMI lfow frame and the index of microcirculatory resistance (IMR) were examined, their relationships to SCF were analyzed. Results: Compared with Control group, the patients in SCF group showed the lower levels of HLL-C (1.57 ± 0.38) mmol/L vs (1.62 ± 0.43) mmol/L and Apo-A1 (1.41 ± 0.31) mmol/L vs (1.57 ± 0.38) mmol/L, while higher level of hs-CRP (3.63 ± 1.67) μg/mL vs (1.74 ± 0.75) μg/mL; SCF groups had increased IMR (29.28 ± 7.68) vs (24.94 ± 6.67), all P<0.05. IMR was positively related to TIMI lfow frame (r=0.766, P=0.019) and hs-CRP (r=0.565, P=0.000). Conclusion:①Microcirculatory dysfunction was related to SCF.②Inlfammatory reaction, decreased blood levels of HDL-C and Apo-A1 might be involved in pathological process of SCF.

Anxiety, Depression, and General Psychological Distress in Patients with Coronary Slow Flow / Ansiedade, Depressão e Distúrbios Psicológicos Gerais em Pacientes com Fluxo Coronariano Lento

AbstractBackground:The relationship between psychiatric illness and heart disease has been frequently discussed in the literature. The aim of the present study was to investigate the relationship between anxiety, depression and overall psychological distress, and coronary slow flow (CSF).Methods:In total, 44 patients with CSF and a control group of 50 patients with normal coronary arteries (NCA) were prospectively recruited. Clinical data, admission laboratory parameters, and echocardiographic and angiographic characteristics were recorded. Symptom Checklist 90 Revised (SCL-90-R), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scales were administered to each patient.Results:The groups were comparable with respect to age, sex, and atherosclerotic risk factors. In the CSF group, BAI score, BDI score, and general symptom index were significantly higher than controls (13 [18.7] vs. 7.5 [7], p = 0.01; 11 [14.7] vs. 6.5 [7], p = 0.01; 1.76 [0.81] vs. 1.1[0.24], p = 0.01; respectively). Patients with CSF in more than one vessel had the highest test scores. In univariate correlation analysis, mean thrombolysis in myocardial infarction (TIMI) frame counts were positively correlated with BAI (r = 0.56, p = 0.01), BDI (r = 0.47, p = 0.01), and general symptom index (r = 0.65, p = 0.01). The psychiatric tests were not correlated with risk factors for atherosclerosis.Conclusion:Our study revealed higher rates of depression, anxiety, and overall psychological distress in patients with CSF. This conclusion warrants further studies.

ResumoFundamento:A investigação da relação entre doença psiquiátrica e doença cardíaca sempre foi um tema de interesse na literatura médica.Objetivo:Investigar a relação entre ansiedade, depressão e distúrbios psicológicos gerais e fluxo coronariano lento (FCL).Métodos:Quarenta e quatro pacientes com FCL e 50 pacientes com fluxo coronariano normal (FCN) foram recrutados prospectivamente. Foram registrados: dados clínicos, parâmetros laboratoriais à admissão e características ecocardiográficas e angiográficas. Escalas de avaliação da Lista de Verificação de Sintomas-90 Revisada (SCL-90-R), do Inventário Beck de Depressão (IBD) e do Inventário Beck de Ansiedade (IBA) foram determinadas para cada paciente.Resultados:O grupo FCL incluiu 44 indivíduos e o grupo controle 50 indivíduos. Os grupos foram comparados quanto à idade, sexo e fatores de risco para aterosclerose. No grupo FCL, os escores do IBA, do IBD e do índice geral de sintomas foram significativamente mais altos que no grupo controle (13 [18,7] vs. 7,5 [7], p = 0,01; 11 [14,7] vs. 6,5 [7], p = 0,01; 1,76 [0,81] vs. 1,1[0,24], p = 0,01; respectivamente). Pacientes com FCL em mais de um vaso apresentaram os escores mais elevados. Na análise de correlação univariada, a média das contagens de quadros TIMI foi correlacionada positivamente com o IBA (r = 0,56, p = 0,01), com o IBD (r = 0,47, p = 0,01) e com o Índice Geral de Sintomas (r = 0,65, p = 0,01). Os testes psiquiátricos não tiveram correlação com fatores de risco para aterosclerose.Conclusão:Nosso estudo revelou taxas de depressão, ansiedade e distúrbios psicológicos gerais mais elevadas em pacientes com FCL. Esta conclusão justifica novos estudos.

Effects of ischemia and omeprazole preconditioning on functional recovery of isolated rat heart / Efeitos da isquemia e pré-condicionamento com omeprazol na recuperação funcional do coração isolado de rato

Abstract Objective: The aim of this study was to compare protective effects of ischemic and potential protective effects of pharmacological preconditioning with omeprazole on isolated rat heart subjected to ischemia/reperfusion. Methods: The hearts of male Wistar albino rats were excised and perfused on a Langendorff apparatus. In control group (CG) after stabilization period, hearts were subjected to global ischemia (perfusion was totally stopped) for 20 minutes and 30 minutes of reperfusion. Hearts of group II (IPC) were submitted to ischemic preconditioning lasting 5 minutes before 20 minutes of ischemia and 30 minutes of reperfusion. In third group (OPC) hearts first underwent preconditioning lasting 5 minutes with 100μM omeprazole, and then submitted 20 minutes of ischemia and 30 minutes of reperfusion. Results: Administration of omeprazole before ischemia induction had protective effect on myocardium function recovery especially regarding to values of systolic left ventricular pressure and dp/dt max. Also our findings are that values of coronary flow did not change between OPC and IPC groups in last point of reperfusion. Conclusion: Based on our results it seems that ischemic preconditioning could be used as first window of protection after ischemic injury especially because all investigated parameters showed continuous trend of recovery of myocardial function. On the other hand, preconditioning with omeprazole induced sudden trend of recovery with positive myocardium protection, although less effective than results obtained with ischemic preconditioning not withstand, we must consider that omeprazole may be used in many clinical circumstances where direct coronary clamping for ischemic preconditioning is not possible. .

Resumo Objetivo: O objetivo deste estudo foi comparar os efeitos protetores de efeitos protetores isquêmicos e potenciais de précondicionamento farmacológico com omeprazol no coração isolado de rato submetido à isquemia/reperfusão. Métodos: Os corações de ratos albinos Wistar machos foram excisados e perfundidos em um aparelho de Langendorff. No grupo controle (grupo I), após o período de estabilização, os corações foram submetidos à isquemia global (a perfusão foi totalmente interrompida) por 20 minutos e 30 minutos de reperfusão. Corações do grupo II (IPC) foram submetidos a précondicionamento isquêmico com duração de 5 minutos antes de 20 minutos de isquemia e 30 minutos de reperfusão. No terceiro grupo (OPC), corações foram submetidos a pré-condicionamento com duração de 5 minutos com 100 μM de omeprazol, e, então, submetidos a 20 minutos de isquemia e 30 minutos de reperfusão. Resultados: A administração de omeprazol antes da indução da isquemia teve efeito protetor sobre a recuperação funcional do miocárdio especialmente em relação aos valores de pressão sistólica ventricular esquerda e dp/dt max. Também os nossos achados são de que os valores de fluxo coronário não se alteraram entre os grupos OPC e IPC no último ponto de reperfusão. Conclusão: Com base nos nossos resultados, o pré-condicionamento isquêmico poderia ser usado como primeira janela de proteção após a lesão isquêmica, especialmente porque todos os parâmetros analisados apresentam tendência contínua de recuperação da função do miocárdio. Por outro lado, o pré-condicionamento induzido com omeprazol apresenta tendência repentina de recuperação com proteção miocárdio positiva, embora menos efetiva da obtida com o pré-condicionamento isquêmico. Devemos considerar que o omeprazol pode ser usado em muitas circunstâncias clínicas em que o pinçamento coronariano direto para pré-condicionamento isquêmico não é possível. .

Right-sided reverse T composite arterial grafting to complete revascularization of the right coronary artery / Enxerto arterial composto reverso T do lado direito para completar a revascularização da artéria coronária direita

Complete arterial revascularization for the right coronary artery is underused mainly due to technical issues. Herein we report on a new approach for complete arterial revascularization of arterial revascularization for the right coronary artery branches. Complete arterial revascularization for the right coronary artery revascularization was performed in 8 patients using a reverse T composite arterial graft. None of the patients suffered perioperative myocardial infarction. All patients underwent noninvasive coronary imaging, displaying an early patency rate of 100%. Complete arterial arterial revascularization for the right coronary artery revascularization using a reverse T graft offers a new paradigm with enhanced technical flexibility in performing all arterial myocardial complete revascularizations in selected patients.

Revascularização arterial completa para a artéria coronária direita é subutilizada, principalmente devido a problemas técnicos. Nós relatamos uma nova abordagem para a revascularização arterial completa para os ramos da artéria coronária direita. Revascularização arterial completa da artéria coronária direita foi realizada em 8 pacientes usando um enxerto T arterial composto inverso. Nenhum dos pacientes sofreu infarto do miocárdio perioperatório. Todos os pacientes foram submetidos a exame de imagem não invasivo coronária não invasiva, exibindo taxa de patência precoce de 100%. Revascularização arterial completa da artéria coronária direita com enxerto inversa T oferece um novo paradigma com maior flexibilidade técnica na execução todas as revascularizações arteriais completas do miocárdio em pacientes selecionados.

Morphologic expression of the left coronary artery in pigs. An approach in relation to human heart / Expressão morfológica da artéria coronária esquerda em porcos. Abordagem em relação ao coração humano

Introduction: In spite of its importance as an experimental model, the information on the left coronary artery in pigs is sparse. Objective: To determine the morphologic features of the left coronary artery in pigs. Methods: We evaluated 158 pig hearts. The left coronary artery was perfused with synthetic resin after their ostia had been catheterized. Diameters and courses of the vascular beds were measured with an electronic caliper (Mitutoyo(r)). Results: The diameter of left coronary artery was 6.98 ± 1.56 mm and its length was 3.51±0.99 mm. It was found to end up by bifurcating itself into the anterior interventricular artery and the circumflex artery in 79% of the cases, and by trifurcating in 21% of the cases, with the presence of the diagonal artery. The anterior interventricular artery ended up at the apex in 79.7% of the cases, and the circumflex artery at the posterior aspect of the left ventricle in 64% of the case, this artery never reached the posterior interventricular sulcus. An anastomosis between the terminal branches of the anterior interventricular artery and the posterior interventricular artery was found in 7.6% of the specimens. The antero-superior branch of the anterior interventricular artery occurred in 89.9% of the hearts. A left marginal branch was observed in 87.9% of the cases with a diameter of 2.25±0.55 mm. Conclusion: Compared with humans, pigs have shorter left coronary artery trunks and branches; even the circumflex artery never reaches the posterior interventricular sulcus. Our findings are useful for the design of experimental hemodynamic and procedural models. .

Introdução: Apesar de sua importância como modelo experimental, a informação sobre a artéria coronária esquerda em suínos é escassa. Objetivo: Determinar as características morfológicas da artéria coronária esquerda em suínos. Métodos: Foram avaliados 158 corações de porcos. A artéria coronária esquerda foram perfundidos com resina sintética após a sua óstios foram cateterizados. Diâmetros e cursos dos leitos vasculares foram medidos com um paquímetro eletrônico (Mitutoyo(r)). Resultados: O diâmetro da artéria coronária esquerda foi 6,98±1,56 mm e seu comprimento era de 3,51±0,99 mm. Verificou-se que acabam bifurcando-se no interior da artéria descendente anterior e da artéria circunflexa em 79 % dos casos, e dividindo-se em três em 21% dos casos, com a presença da artéria diagonal. A artéria interventricular anterior acabou no ápice em 79,7% dos casos, sendo a artéria marginal na face posterior do ventrículo esquerdo em 64% dos casos, esta artéria nunca chegou ao sulco interventricular posterior. Uma anastomose entre os ramos terminais da artéria interventricular anterior e artéria interventricular posterior foi encontrado em 7,6% das amostras. O ramo ântero-superior da artéria interventricular anterior ocorreu em 89,9% dos corações. Um ramo marginal esquerda foi observado em 87,9% dos casos, com diâmetro de 2,25±0,55 mm. Conclusão: Em comparação com os seres humanos, os porcos têm troncos das artérias coronárias esquerdas mais curtos e ramos; até a artéria circunflexa nunca atinge o sulco interventricular posterior. Nossos resultados são úteis para a concepção de hemodinâmica experimental e modelos processuais. .

Clinical observation of tirofiban for emergency interventional therapy in patients with acute ST segment elevation myocardial infarction / 中国医师进修杂志

Objective To investigate the efficacy and safety of tirofiban for emergency interventional therapy in patients with acute ST segment elevation myocardial infarction.Methods The 96 acute ST segment elevation myocardial infarction patients having accepted emergency percutaneous coronary intervention (PCI) were divided into treatment group and control group according to the treatment method with 48 cases each.The treatment group was given conventional standard treatment combined with tirofiban treatment [tirofiban intracoronary injection 10 μ g/kg and then intravenous 0.15 μ g/(kg· min) for 24-48 h].The control group was given conventional standard treatment only.The postoperative 60 min electrocardiogram ST segment recovery,the coronary blood flow TIMI grade,the major adverse cardiac events (angina,myocardial infarction,heart failure,death) and postoperative bleeding in 4 weeks were compared between the two groups.Results The patients having postoperative 60 min electrocardiogram ST segment recovery in treatment group was 45 cases (93.8％,45/48),in control group was 35 cases (72.9％,35/48),and there was statistical difference (P ＜ 0.05).The incidence rate of infarction vascular TIMI grade ≥ 3 grade flow in treatment group was 95.8％ (46/48),in control group was 75.0％ (36/48),and there was statistical difference (P ＜ 0.05).The incidence rate of the major adverse cardiac events 4 weeks in treatment group was significantly lower than that in control group,and there was statistical difference (P ＜ 0.05).There was no statistical difference in the incidence rate of bleeding between the two groups (P ＞ 0.05).Conclusion In patients with acute ST segment elevation myocardial infarction,the emergency interventional therapy with tirofiban is efficacy and safety.