冠状静脉解剖变异对左心室电极置入成功率的影响

Anatomy variation of coronary vein system in patients with ischemic heart disease and non-ischemic heart disease

目的 了解冠状静脉解剖形态的改变,为成功置入左心室电极提供依据.方法 128例患者,男101例,平均年龄（63.5 ±10.6）岁.其中缺血性心肌病（IHD）41例,均经冠状动脉造影诊断（狭窄≥50%）,非缺血性心肌病（NIHD）87例.结果 127例完成冠状静脉造影,1例冠状窦插管失败;123例（96.09%）经静脉将左心室起搏电极导线送至心脏静脉的分支.心侧静脉及心后侧静脉异常（细小、狭窄、扭曲、缺如）占76.38%,心侧静脉细小、扭曲和累计血管变异均明显多于心后侧静脉（P〈0.05～0.01）,而心后侧静脉缺如则明显多于心侧静脉（P〈0.05）.心侧静脉和心后侧静脉同时存在变异占25.20%.男性靶静脉缺如比率多于女性（P〈0.05）,女性靶静脉细小及扭曲明显高于男性（P〈0.05）.心后侧静脉缺如、细小或双支靶静脉均有变异在IHD组明显多见（均为P〈0.05）,冠状静脉窦肌桥均发生在NIHD组.IHD亚组分析,左前降支及左回旋支病变主要伴心侧静脉变异.结论 心侧静脉和心后侧静脉的解剖变异发生率高,男性靶静脉缺如发生率明显高于女性,女性靶静脉细小发生率明显高于男性.IHD血管变异比率明显高于NIHD,冠状动脉病变及心肌梗死部位对静脉变异有一定的影响.

Objective The purpose of this study was to analyze the anatomy variation of coronary vein system in patients with ischemic heart disease （IHD） and non-ischemic heart disease （NIHD）.Method Forty-one patients with IHD and 87 patients with NIHD [101 men, mean age （63.5 ± 10. 6）years] were included in this study. Results Coronary sinuses were successfully cannulated and venographies were obtained in 127 cases. Transvenous LV pacing leads were successfully placed in optimal coronary vein in 123 cases （96. 09% ）. The majority （76. 38% ） patients had at least one or more vessel abnormalities （thinness, stenosis, tortuousity, lack of lateral marginal vein or postero-lateral vein）. The incidence of thin and tortuousity was significantly higher in lateral marginal vein than that in postero-lateral vein （P 〈0. 05 -0. 01 ）. The incidence of lack of postern-lateral marginal vein was more frequent than the lack of lateral vein （P 〈 0. 05 ）. The rate of abnormality in both vessels was 25. 2%. Incidence of vein lack in male was more frequent than in female （ P 〈 0. 05 ）. The thin and tortuousity of vessels in female were more frequent than in male （ P 〈 0. 05 ） . The incidence of thin and tortuousity of postero-lateral and abnormality of both vessels was significantly higher in IHD than in NIHD patients （ P 〈 0. 05 ）. All coronary sinus myocardial bridges occurred in NIHD. Stenoses of left anterior descending （LAD） and left circumflex （LCX） were mostly associated with abnormality of lateral vessels. Conclusions The anatomic variations of lateral and postern-lateral coronary vein were more frequent in this patient cohort. Vein lack in male was more frequent and the thin and tortuousity of vessels were less in male than in female patients. The ratio of vessel abnormality is higher in patients with IHD. Coronary arteries stenosis and position of infarction are associated with anatomic variations of coronary vein system.