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双源CT冠状动脉血管成像的临床应用The Clinical Application of Dual-source Computed Tomography Coronary Angiography杨贞勇谢学斌郭汉霖Yang Zhen-yong Xie Xue-bin Guo Han-li澳门镜湖医院影像中心Department of Imaging, Kiang Wu Hospital, Macau SAR, China中图分类号：R814.42 文献标识码：A 文章编号：1818－0086（2010）04摘要：目的探讨双源CT（DSCT）冠状动脉成像的临床应用价值。
方法回顾性分析2009.6～2010.2期间139例行双源CT（DSCT）冠状动脉成像检查的病例，男75 例，女64 例，年龄43～76岁。
图像品质评价分4级：优秀（4分），无伪影，完全可进行影像学分析；良好（3分），轻微伪影，有良好的诊断品质，可进行影像学分析；尚可（2分），中度伪影，能满足诊断分析；差（1分），严重伪影，不能满足诊断分析。
狭窄程度评价方法：血管狭窄程度=（狭窄血管近心端正常血管直径-狭窄处直径）/狭窄近心端血管直径×100%；冠状动脉狭窄分级：轻度为管径狭窄<50%，中度为≥50%且≤75%，重度≥75%，血管闭塞(100%)。
结果139例冠状动脉成像，137例显示良好（2分以上），符合诊断要求。
CTA成像成功率98.6%，发现血管异常85例，其中冠状动脉斑块所致狭窄70例，冠状动脉肌桥32例，冠状动脉起源异常5例（4例为右冠状动脉异位起源于左冠状动脉窦，1例为冠状动脉起源于冠状动脉窦上方），主动脉瓣结节1例，冠状动脉-肺动脉瘘1例，双侧上腔静脉1例。
同时行双源CT冠状动脉成像和冠状动脉造影检查（CAG）病人17例，符合率94%。
结论双源CT（DSCT）冠状动脉成像能提供满意的图像及可靠的诊断结果，以其无创性优势可作为冠心病的首要筛选检查方法之一关键字：冠状动脉；双源CT；血管造影术Abstract：Objective To evaluate the clinical application of dual-source computed tomography coronary angiography (DSCTCA). Methods Between June 2009 and February 2010, dual-source computed tomography coronary angiography (DSCTCA) was performed in 139 cases (male 75, female 64, age from 43 to 76 years). Image quality degrees: excellent (Score 4): no artifact; good (Score 3): a little artifact that does not affect the diagnosis; satisfaction (Score 2): moderate artifact that does not affect the diagnosis significantly; poor (Score 1): serious artifact that affect the diagnosis significantly. Stenosis degrees: mild stenosis<50%，50%≥moderate stenosis≤75%, serious stenosis≥75%, occlusion (100%). Results The images of 137 of 139 cases (98.6%) are satisfied or above. There are 85 abnormal cases of 139 found. Among them, stenoses are found in 70 cases, myocardial bridging in 32 cases, abnormal arising position in 5 cases (RCA originates from left coronary sinus in 4 cases, both RCA and LCA originate from the points above coronary sinus in 1 case), nodule at aortic valve leaflet in 1 case, both RCA and LCA -PA fistula 1 case, both SVC in 1 case. 94% got the same diagnosis in 17 cases that were also examined by conventional coronary angiography (CAG). Conclusion Dual-source computedtomography coronary angiography (DSCTCA) can provide satisfied images and diagnosis. It can be one of the best screening methods for coronary disease.Key words：Coronary artery; Tomography; X-ray computed; DSCT; Angiography冠状动脉的无创性成像一直是放射学家孜孜追求的目标之一。
左右冠状动脉-肺动脉瘘1例（关键词）冠状动脉造影；冠状动脉-肺动脉瘘；胸闷；冠状动脉肺动脉瘘是先天性疾病，该疾病主要就是冠状动脉与心腔及其他血管之间的异常通道，血液通过该通道分流到相关的心腔和血管。
现报告冠状动脉双瘘（左右冠状动脉-肺动脉瘘）1例：1.病历简介：患者男性，46岁，以“阵发性胸闷3年，再发3天”入院；3年前，患者于劳累后出现胸闷症状，呈憋闷样，心前区为著，无左臂放射痛，无大汗淋漓，无恶心、呕吐，无头晕、黑矇等症状，持续1分钟，休息后缓解，未治疗。
3年来，患者上述症状间断发作，均以活动后为著，持续数分钟，休息后缓解，一直未系统诊治。
3天前，患者无明显诱因再发胸闷症状，持续3分钟，无气短、心前区疼痛，无出汗，无濒死感，休息后逐步缓解，未治疗。
3天来，患者未行特殊治疗，上述症状偶有发作。
发病以来，无口苦、反酸，无头晕、心慌，无咳嗽、咳痰，无咳血，无夜间阵发性呼吸困难，食纳夜休可，大小便正常。
既往有糖尿病病史3年，口服“二甲双胍片”，未监测。
有脂肪肝病史。
有吸烟及饮酒病史，父亲有冠心病病史，母亲有高血压病、糖尿病病史；查体：体温：36.2℃，脉搏：70次/分，呼吸：20次/分，血压：120/88mmHg。
双肺呼吸音清，未闻及干湿性啰音。
心浊界不大，心率70次/分，律齐，心音正常，各瓣膜听诊区未闻及病理性杂音。
腹平软，全腹无压痛，双下肢无水肿。
心电图示：大致正常；入院查胸部CT示：两肺纹理增重；主动脉钙化；脂肪肝。
颈部血管超声示：双侧颈动脉粥样硬化伴双侧颈总动脉粥样硬化斑块形成，右侧锁骨下动脉粥样硬化斑块形成。
腹部超声示：脂肪肝，胆胰脾声像未见明显异常。
颈椎MR示：颈3-4、颈4-5、颈5-6椎间盘突出，颈6-7、颈7-胸1椎间盘轻度膨出。
心脏超声示：EF74%，左室前壁运动搏幅减低，主动脉硬化，左室舒张及收缩功能正常。
血脂示：TG：2.86mmol/L，血同型半胱氨酸28.9umol/L；查头颅CT、LP-PLA2、FABP、BNP、TNI、心肌酶谱、肝功、肾功、电解质、血脂、凝血系列、甲功、血常规、尿常规、粪常规、心输出量、心脏指数、加速度指数、外周血管阻力、13C呼气试验、糖化血红蛋白等未见明显异常。
Transcatheter aortic valve implantation fortreating severe aortic stenosisZHENG Juanjuan1，2， SI Yueqiao1， YANG Dezhong1， LIU Yukai1，WANG Hongyong1， ZENG Chunyu1， WANG Wei1，2*（1.Department of Cardiology， Daping Hospital， Army Medical University， Chongqing 400042， China；2.Department of Geriatrics， Southwest Hospital， Army Medical University， Chongqing 400038， China）［Abstract］Objective To observe the effect of transcatheter aortic valve implantation （TAVI） for treating severe aortic stenosis （AS）.Methods Data of 18 patients with severe AS who underwent TAVI were retrospectively analyzed.The immediately success rate of TAVI was recorded，and the intraoperative and postoperative complications were observed.The valve function was evaluated，and cardiovascular events during 1 month’and 3 months’following-up period after treatment were recorded.Results Among 18 cases，3 patients with coronary heart disease were treated with one-step TAVI＋percutaneous coronary intervention （PCI），2 with high risk of coronary artery occlusion were treated under “chimney” or “windowing” stent pre-protection， 1 with refractory heart failure was treated with TAVI under protection of extracorporeal membrane oxygenator （ECMO），while 1 case with uremia underwent hemodialysis on the day before TAVI and the day of TAVI after interventional procedures. The immediate operation success rate of TAVI was 100% （18/18）.During treatment， 1 case was transferred to surgery due to cardiac tamponade， another valve implantation was performed in1 case since moderate perivalvular leakage after implantation of the first d perivalvular leakage was found in 3cases after treatment.Implantation of permanent pacemaker was performed in 1 patient for third degree atrioventricular block. No other serious complication occurred. Immediately， 1 month and 3 months after treatment， aortic orifice flow rate （［203.47±70.65］，［219.64±67.49］，278.00 ［188.50，289.00］cm/s）and pressure gradient （［17.16±14.05］，0 ［0，20.50］，12.00［0，32.50］mmHg）showed by echocardiography decreased compared to those before treatments （470.50 ［428.75，553.25］cm/s，79.50 ［53.25，112.50］mmHg）（all P＜0.05）.No severe cardiovascular event，such as death， stroke， acute coronary syndrome nor new onset atrial fibrillation occurred within 3 months after treatment.Conclusion TAVI was safe for treating severe AS with good short-term efficacy.［Keywords］aortic valve stenosis； heart valve prosthesis implantation； treatment outcomeDOI：10.13929/j.issn.1672-8475.2023.11.003经导管主动脉瓣植入术治疗重度主动脉瓣狭窄郑娟娟1，2，司月乔1，杨德忠1，刘渔凯1，王红勇1，曾春雨1，王伟1，2*（1.陆军军医大学大坪医院心血管内科，重庆 400042； 2.陆军军医大学西南医院老年科，重庆 400038）［摘要］目的 观察经导管主动脉瓣植入术（TAVI）治疗重度主动脉瓣狭窄（AS）的效果。
