主动脉夹层动脉瘤术前心肌SPECT显像必要性初探

The study of the necessity of preoperative myocardial SPECT imaging in patients with dissecting aneurysm of aorta

目的探讨主动脉夹层动脉瘤患者术前行心肌ＳＰＥＣＴ显像的必要性。方法３０例经外科手术证实的主动脉夹层动脉瘤患者，术前均进行潘生丁负荷和静息心肌断层显像，２次显像间隔２４ｈ～１周，其中２例行冠状动脉造影检查。结果３０例病人中ＤｅｂａｃｋｅｙⅠ型２０例，ＤｅｂａｃｋｅｙⅢ型１０例。１９例心肌断层显像正常，其中１８例手术成功，１例术后死于急性下壁心肌梗死，手术死亡率５２６％。１１例病人心肌显像异常，其中５例手术成功，６例因术后心肌复跳无力或心功能低下死亡；６例中手术见ＤｅｂａｃｋｅｙⅠ型５例，夹层裂口撕至右冠状动脉开口３例，夹层内充满血栓或粥样斑块２例，ＤｅｂａｃｋｅｙⅢ型１例合并主动脉内膜粥样斑块形成，死亡率为５４５５％。结论主动脉夹层动脉瘤患者术前进行潘生丁负荷心肌断层显像。

Objective To study the necessity of dipyrodamole stress myocardial SPECT imaging before the operation in patients with dissecting aneurysm of aorta Methods 30 patients with diagnosed dissecting aneurysm of aorta were included in this study All of them underwent dipyridamole stress and rest myocardial SPECT imaging separately before operation with 1～7 days' interval between two modalities Two of the patients also underwent coronary angiography Results According to the findings in operation, of the 30 patients, 20 belonged under Debackey Ⅰ and 10 under Debackey Ⅲ In the 19 patients with normal SPECT imaging, 18 had successful operations while the remaining one died of acute inferior wall infarction after operation The mortality was 5 26% In the 11 patients with abnormal SPECT imaging, 5 had successful operations while 6 died of cardiac insufficiency or low cardiac output syndrome Of the 6 cases who died right in or after the operation, 5 belonged to Debackey Ⅰ and 3 had sandwiches torn to the opening of the right coronary artery Of these 3 patients, 2 had the sandwiches filled with thrombi or atheromatous plaque, the other one belonged to Debackey Ⅲ accompained by the formation of aortic atheromatous plaque The mortality was 54 55% Conclusions Dipyridamole stress myocardial SPECT imaging is necessary for prognostication before operation for patients with dissecting aneurysm of aorta, especially for patients belonging to Debackey Ⅰ