CAJ | 학술논문

目的研究心脏再同步治疗(CRT)患者心脏静脉系统血流异常情况,以便左心室电极导线植入.方法 109例植入CRT患者,男性67例,女性42例,年龄46-84(61.8±14.2)岁,其中扩张性心肌病90例,高血压性心脏病15例,缺血性心肌病4例,心功能Ⅲ～Ⅳ级(NYHA分级).通过采用后前位、左前斜和右前斜3种不同X线体位,分别经冠状静脉窦逆行灌注显像或经冠状动脉造影延迟顺行心脏静脉显像,观察心脏静脉系统血流异常的情况,总结心脏静脉系统解剖变异特点.结果心脏静脉系统造影显像提示37例(33.9%)植入CRT患者存在不同程度的心脏静脉系统血流异常,其中冠状静脉窦口或窦体异常者15例(13.8%),心脏静脉分支异常者22例(20.1%).经心脏静脉系统而完成CRT植入术的成功率为99%,左心室电极导线脱位发生率为2%,未出现严重并发症病例.结论心脏静脉系统血流异常是心力衰竭患者比较常见的现象,绝大部分左心室电极导线植入均能经心脏静脉系统顺利完成.
목적 연구심장재동보치료(CRT)환자심장정맥계통혈류이상정황,이편좌심실전겁도선식입.방법 109례식입CRT환자,남성67례,녀성42례,년령46-84(61.8±14.2)세,기중확장성심기병90례,고혈압성심장병15례,결혈성심기병4례,심공능Ⅲ～Ⅳ급(NYHA분급).통과채용후전위、좌전사화우전사3충불동X선체위,분별경관상정맥두역행관주현상혹경관상동맥조영연지순행심장정맥현상,관찰심장정맥계통혈류이상적정황,총결심장정맥계통해부변이특점.결과 심장정맥계통조영현상제시37례(33.9%)식입CRT환자존재불동정도적심장정맥계통혈류이상,기중관상정맥두구혹두체이상자15례(13.8%),심장정맥분지이상자22례(20.1%).경심장정맥계통이완성CRT식입술적성공솔위99%,좌심실전겁도선탈위발생솔위2%,미출현엄중병발증병례.결론 심장정맥계통혈류이상시심력쇠갈환자비교상견적현상,절대부분좌심실전겁도선식입균능경심장정맥계통순리완성.
Objective To investigate the anatomic variation of coronary venous system in patients with cardiac resynchronization therapy (CRT) as to yield greater success in left ventricular(LV) lead implantation.Methods One hundred and nine patients[67 men and 42 women,mean age (61.8 ± 14.2 )years ] suffering from heart failure,who received CBT,were selected.The etiologies of heart failure were idiopathic dilated cardiomyopathy in 90 patients,ischemic cardiomyopathy in 15 patients and hypertensive cardiomyopathy in 4 patients.A detailed coronary venogram was obtained through retrograde or antegrade venography at the views of anteropesterior ( AP ) ,left anterior oblique ( LAO ) and right anterior oblique (RAO).The anatomical variations of the coronary venous system were analyzed.Results The anatomic variations was discovered in 37(33.9% ) patients receiving CRT,among which 15(13.8%) patients had the coronary sinus(CS) ostium abnomalities and 22 (20.1% )had the coronary side branches abnomalities.The LV lead insertion success rate was achieved in 99% of patients through coronary venous access,the incidence of LV lead dislodgement was 2% ,and no patient was found with serious complications.Conclusion Although the coronary sinus side branches is variable in cardiomyopathy population,in most cases the LV lead can be safely inserted through coronary venous approach.