心脏瓣膜手术前行冠状动脉造影及同期行冠状动脉旁路移植术分析

Clinical analysis of preoperative coronary angiography before valvular surgery with concomitant coronary artery bypass grafting

目的探讨心脏瓣膜病患者术前选择性行冠状动脉造影及同期施行冠状动脉旁路移植术的效果及经验.方法对211例50岁以上行心脏瓣膜手术的患者进行统计,其中男104人,女107人,年龄50～75岁(60±3.5岁).术前对有心绞痛等相关症状、糖尿病、高脂血症、心电图存在缺血等冠心病高危因素的患者行冠状动脉造影,冠状动脉狭窄超过50%为阳性,狭窄超过75%(左主干超过50%)者同期行冠状动脉旁路移植术.结果 211例患者中行冠状动脉造影术128例(60.7%,其余患者无症状及相关危险因素未造影),其中30例冠状动脉存在单支或多支病变,狭窄程度>50%,造影阳性率23.4%.同期行冠状动脉旁路移植术24例(80.0%),手术死亡1例,其余患者随诊4～38个月,效果良好.结论 50岁以上瓣膜病患者术前行冠状动脉造影可为术前诊断和排除冠心病、选择术式提供帮助.

Objective To summarize the clinical experience of coronary angiography before coronary artery grafting （CABG） with concomitant valvular surgery in patients with valvlar disease. Methods From April 2000 to May 2005, two hundred and eleven patients over 50 years old （mean age 60 3.5） with valvlar diseases were studied retrospectively. Coronary angiography was utilized for patients who were found to have risk factors for atherosclerosis. Coronary stenosis over 500% of its calibre was considered positive, and 75% stenosis （including LMCA stenosis more than 50%） was used as the indication for coronary artery bypass surgery. Results Coronary angiography was employed in 128 patients and 30 cases （23. 4%） had coronary artery stenosis exceeding 50%. CABG was concomitantly performed during cardiac valvular surgery in 24 patients. In-hospital mortality in patients with valve surgery alone was 0. 5%, which was significantly lower compared with patients with valve surgery combined with CABG group （4.2%）（P〈0. 05）. Conclusion Coronary angiography is necessary for patient more than 50 years old who are candidate of valve surgery.