孤立性左冠状动脉主干狭窄17例临床分析

Isolated Left Main Coronary Artery Stenosis:Report of 17 Cases

目的 :探讨孤立性左冠状动脉主干 (左主干 )狭窄的临床特点、造影所见及治疗方法。 方法 :1确立左主干狭窄≥ 5 0 % ,而其它三大主要冠状动脉支及其分支均无明显狭窄为孤立性左主干狭窄。 2冠状动脉造影常规采用 Judkin's法完成 ,于右前斜位 30°投照行左心室造影 ,观察左心室壁运动并计算左心室射血分数(L VEF)。 结果 :1冠状动脉造影 4942例中检出孤立性左主干狭窄 17例 ,占 0 .34 %。 2 16例 (94.1% )表现为劳力型或恶化劳力型心绞痛 ,10例 (5 8.8% )于心绞痛发作时心电图 V3～ 5 导联 ST段下移 0 .2～ 0 .4m V,3例 (17.6 % )有心肌梗塞史。 3左心室造影 5例 (2 9.4% )有轻度节段性心室壁运动障碍 ,平均 L VEF 0 .6 9± 0 .0 8。 4左主干狭窄部位 :开口部 9例 (5 2 .9% ) ,中段 3例 (17.6 % ) ,分叉前 5例 (2 9.4% )。5 12例 (70 .6 % )行冠状动脉旁路移植术 (CABG) ,术后 11例 (91.7% )心绞痛消失。 2例行经皮冠状动脉腔内成形术 (PTCA)及支架植入术 (ICS) ,取得良好效果。 2例内科保守治疗 ,1例造影后死亡。 结论 :临床上孤立性左主干狭窄非常少见 ,大多数患者心绞痛症状严重 ,病因以动脉粥样硬化最常见。治疗以冠状动脉旁路移植术效果最佳。

Objective:To study the clinical features,findings of coronary angiography and treatment in patients(pts)with isolated left main coronary artery(LM)stenosis. Methods:①Isolated LM stenosis was defined as the stenotic lesion≥50% in any portion of LM with no significant lesion in the remaining major coronary arteries and their branches.②Coronary angiography(CAG)was performed by Judkin's method and left ventriculography was completed on RAO 30°.The left ventricular ejection fraction(LVEF)was calculated. Results:①Among 4942 pts.who underwent CAG,17 pts.(0.3%)were found to have a significant isolated stenosis located at the LM.②Sixteen pts.(94.1%)of them had severe angina with ST V3～V5 depressed 0.2～0.4 mV during the episodes of angina.Myocardial infarction was found in 3.③Left ventriculogram showed that five cases had segmental hypokinetic wall motion with an average LVEF of 0 69±0 08,④CAG showed the stenosis located at the ostium of the LM in 9 pts.(52.9%),3 had midportion lesion,and 5 had distal lesion of the LM.⑤Twelve pts (70.1%)underwent coronary artery bypass grafting(CABG),and angina disappeared in 11.Two pts with midportion lesion underwent percutaneous transluminal coronary angioplasty(PTCA) and coronary stenting.Two pts.were treated with medication.One died after CAG. Conclusion:An isolated stenosis of LM is a rare angiographic finding.most of the pts have severe angina.Atherosclerosis is the most common cause of severe LM stenosis and CABG is the best method for treatment.