左冠状动脉主干慢性完全闭塞13例临床分析  

Total Occlusion of Left Main Coronary Artery-Clinical Analysis of 13 Cases

作　　者：陈珏[1] 姚民[1] 吴元[1] 尤士杰[2] 陈纪林[2] 姚康宝[2] 杨跃进[2] 秦学文[2] 乔树宾[2] 高润霖[2] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院冠心病研究室,北京市100037 [2]中国医学科学院

出　　处：《中国循环杂志》1999年第1期17-19,共3页Chinese Circulation Journal

摘　　要：目的：探讨左冠状动脉主干（左主干）慢性完全闭塞患者的临床特征，冠状动脉及左心室造影所见、治疗及预后。方法：对经冠状动脉造影确诊为左主干完全闭塞的13例患者的左心室功能、右冠状动脉侧支循环及临床资料进行分析。结果：①冠状动脉造影4336例中检出左主干完全闭塞13例，占0.29％。②本组13例患者均有典型劳力型心绞痛，11例（84．6％）于心绞痛发作时V3～6导联ST段下移≥0.2mV。③13例患者均为右优势型冠状动脉分布。④12例患者可见来自右冠状动脉丰富的侧支循环，其左心室射血分数（EF）均在正常范围，另1例严重左心室功能障碍者（EF=0.26）侧支循环较差。11例行冠状动脉旁路移植术，术后心绞痛消失。结论：左主干完全闭塞临床上很少见，来自右冠状动脉丰富的侧支循环对维护左心室功能非常重要．但不能防止心绞痛发作。冠状动脉旁路移植术是最佳治疗方法。Objective: To probe into the clinical features, findings of coronary arteriography (CAG ) and left ventriculography(LVG),treatment and prognosis of patients with total occlusion of left main coronary artery (LM).Methods:Thirteen occlusion of LM were diagnosed by CAG. Left ventricular function,collateral circulation from rightcoronary artery and clinical data were reviewed.Results: ①Among 4 336 patients undergone coronary arteriography, thirteen patients were found to have total occlusionof LM,with an incidence of 0. 29%. ②All patients with total occlusion of LM had typical effort angina. Significant ST segment depression(≥0. 2 mV) of V3-6 was found in 11 patients (84. 60% ) during the episodes of angina. ③All patients had adominant right coronary artery. ④Twelve patients with extensive collateral circulation originating from the right coronaryartery (RCA) had normal left ventricular ejection fraction (EF). One patient with poor collateral circulation had serious leftventricular dysfunction (EF=0.26). Coronary bypass surgery was performed in 11 patients,and severe angina disappearedafter operation.Conclusion:Total occlusion of the left main coronary artery is rare clinically. Well developed collateral circulation originating from RCA plays an important role in preserving left ventricular funCtion,but it is insufficient to prevent angina. Coronary bypass surgery is the best therapy.

关 键 词：冠状动脉疾病 侧支循环 冠状动脉分流术 

分 类 号：R654.2[医药卫生—外科学]