心脏再同步治疗的心力衰竭患者冠状静脉解剖形态分析

Analysis of coronary venous anatomy in patients with heart failure undergoing cardiac resynchronization therapy

目的了解冠状静脉解剖形态,为心脏再同步治疗中成功植入左室电极提供依据。方法住院患者113例,男93例,女20例,平均年龄63.5±10.6岁。所有患者均行冠状静脉造影。结果113例中有1支以上血管异常者为97例(85.84%);静脉缺如25例(22.13%),静脉细小36例(31.86%),静脉扭曲19例(16.81%),静脉狭窄5例(4.42%),冠状静脉窦肌桥9例(7.96%)。2例心侧静脉近段发出二级分支,5例心后侧静脉近段发出二级分支。冠状静脉变异与性别无明显关系。非缺血性心肌病心侧静脉和心后侧静脉异常总数明显多于缺血性心肌病(91.25%比72.72%,P<0.05)。冠状静脉窦肌桥均发生在非缺血性心肌病,占11.25%。结论心力衰竭患者冠状静脉解剖具有很大变异性。冠状静脉一级和二级分支的位置、大小等解剖差异与性别、冠状动脉病变或心肌梗死区域无关,非缺血性心肌病的血管变异比例更高。

Objective To explore the anatomy of coronary vein （CV） by means of venography in patients undergoing cardiac resynchronization therapy （CRT）. Methods One hundred and thirteen patients （93 male, mean age： 63.5 ± 10. 6 years） admitted between January 2001 to December 2008 for CRT underwent CV angiography. Results Ninety seven patients （85.84%） had variations of CV branches. A 22. 13% of patients did not have lateral and posterolateral veins and 31.86% had small lateral and posterolateral veins. There were 16. 81% of patients showed tortuosity of target vein（ 〉270°） and 4. 42% showed target vein stenosis and 7.96% of patients with CS myocardial bridge （ stenoses 〉 80% ）. Two patients had side lateral vein branches, and 5 patients had side branches of posterolateral veins. There was no significant relationship between the venous variation and sex. The rate of venous variation was higher in patients with noischemic cardiomyopathy than in patients with ischemic cardiomyopathy （91.25% vs 72.72% ,P 〈 0. 05 ）. Conclusion The variation rate of CV branches was higher in patients with heart failure, which was not related with sex, types of coronary artery lesions and the location of myocardial infarction. Venous variation can be found more in non-ischeamic cardiomyopathy.