冠脉血流显像无创评估心肌梗死缺血区侧支循环的初步临床观察

Preliminary noninvasive observation of coronary collateral flow in patients with myocardial infarction by color Doppler coronary flow imaging

目的 观察冠脉血流显像无创技术对心肌梗死缺血区的侧支循环状况 ,以期建立无创检测缺血区侧支循环新方法。方法 冠心病心肌梗死患者 8例 ,采用心尖两腔切面观察前后降支及心肌内血流 ,左室短轴切面观察前后室间隔支的血流 ,频谱多普勒测量血流速度。结果 8例患者经冠脉造影证实有不同途径的侧支交通 ,后降支与前降支末梢相交通者 5例 ,前降支为逆向充盈、冠脉血流显像检查前降支远端可见收缩期为主和舒张期为主的逆向血流各 1例 ,后降支远端测及舒张期反向血流 1例 ;有前后室间隔支相交通的 6例 (由前间隔支至后室间隔支 2例和后间隔至前间隔支 4例 ) ,冠脉血流显像检查时可见明显增强的前后室间隔支的血流信号并向缺血区延伸 ,频谱显示为舒张期为主的反向血流。造影显示由对角支和回旋支与前降支中部相交通的 2例 ,冠脉血流显像仅探测到对角支内血流增快 ,为 1.5m/s。另外 ,冠脉血流显像在 1例前降支起始部闭塞的患者中观察到由左室腔进入缺血的前壁的血流束 ,频谱以舒张期为主 ,峰速为 0 .49m /s。结论 冠脉血流显像技术可直观显示心肌梗死患者的侧支循环血流 。

Objective To observe the collateral flow by color Doppler coronary flow imaging(CDCFI) system and to establish a noninvasive method to evaluate coronary collateral flow after coronary occlusion.Methods Eight patients with myocardial infarction were examined with CDCFI to observe left anterior descending branch(LAD) and posterior descending branch(PD) flow in the two chamber view, and anterior interventricular septum branches (AIVSB) and posterior interventricular septum branches(PIVSB) flow in the short axis view of left ventricle. The coronary flow pattern and velocity were measured using pulse Doppler.Results Eight patients with myocardial infarction had different collateral flow communication confirmed through coronary angiography(CAG). In 5 cases there were end communication between LAD and PD. Retrograde flow signals were observed in distal LAD in 2 cases and in distal PD in 1 case using CDCFI. Communications of anterior and posterior interventricular septum branches were showed in 6 cases by CAG, the flow signals of AIVSB or PIVSB were enhanced and extend to infarct area, where diastolic predominant retrograde flow was seen by CDCFI.Communications between diagonal branch or circumflex branch and LAD were seen in 2 cases. But only the coronary flow velocity of diagonal branch was increased obviously in one case by pulse Doppler and peak velocity was 1.5 m/s.Some diastolic flow jets from the left ventricular cavity into the anterior wall were seen in one patient with LAD occlusion, and peak velocity was 0.49 m/s.Conclusions The color Doppler coronary flow imaging could show coronary collateral flow in patients with myocardial infarction, and would be used to evaluate the coronary flow as a supplement of CAG in future widely.