| It is common knowledge that,coronary atherosclerotic heart disease has become a major killer hazardous to human health,the physiological and pathology basis of coronary heart disease is that the atheromatous plaque of coronary blood vessel come into being leading the lumen stricture inordinately. It may cause lumen of lumen obstruction, and make the remote coronary artery offer lower blood-supply and oxygen supply lead to cardiac muscle cell necrosis ischemialy and anoxialy, then trigger acute coronary syndrome(ACS) like acute myocardial infarction(AMI)or sudden death. So it is a effective measure to diagnose the primary coronary artery stricture and make some appropriate early intervention to prevent lethality acute coronary syndromes .Sequentially the death rate of angiocardiopathy has reduce largely. Dual Source CT based on high time resolution and spatial resolution, as a kind of non-invasive iconography test method can display every branch of coronary artery distinctly and the stricture degree and part of blood vessel, and the interrelated index of heart function can be determined to assess the stricture degree and the impact to heart function, help to assistant clinical diagnosis order of severity and assessment to curative effect and prognosis of coronary heart disease. At present there is no literature referring to setting single coronary artery stricture to analysis the impact to heart function inordinately, and the impact to heart function of different part of one stricture blood vessel.Objective: this disquisition mainly discuss the evaluation Dual Source CT coronary artery coronary artery evaluate the stricture of ramus descendens anterior arteriae coronariae sinistrae and the affect to the alter of left heart function, accordingly offering bases for clinical diagnosis to coronary artery stricture, heart function assess outcome and prognosis.Materials and methods: select 173 cases of eligible patients who were made dual-source CT coronary CTA examinations. Including 50 cases of normal group selected from the September 2009 to March 2011 in our hospital. Use SOMATOM Definition dual-source 64-slice CT machine of Siemens Corporation. Scan range from 1cm below the tracheal bifurcation to diaphragmatic surface of heart. Take bolus tracking to trigger the next scan. Tracking plane was set at the level of aortic root, action level is 100HU, begin to scan after 5 to 8 seconds delay. Injected dose of contrast medium is 60m. Injection speed is 5ml/s. Ultravist of contrast medium(370 mg/ml)is 60-80ml, 5ml/s and 50ml normal saline. According to the different part, they are divided into three parts: ramus descendens anterior arteriae coronariae, right main coronary artery and normal control. Research the different effect to heart function cause by different embranchment. Then decided who are simple ramus descendens anterior arteriae coronariae sinistrae stricture into four parts; Finally, decided who are serious ramus descendens anterior arteriae coronariae sinistrae stricture into three parts: near-end, middle-end and far-end.Results: (1)Right main coronary artery stricture cause no effect on ejection fraction(EF) of heart. But ramus descendens anterior arteriae coronariae sinistrae stricture cause obvious effect on EF of heart has statistical significance. For myocardial mass, the second group and the control group has difference significantly. Bulk of left ventricle and the control group in period of systole and in relaxation both have no significant differences. Thus for the output per minute, there is no significant difference among every two groups. For stroke output,there is significant difference only between the second group and the control group. This shows left anterior descending branch stricture cause larger effect then right main coronary artery especially in the difference of ejection fraction. And other heart function index have no significant statistical significance. (2)Be grouped according to stricture degree of ramus descendens anterior arteriae coronariae sinistrae Cardiac function which stricture class is IV. Especially ejection fraction index compared with the other three groups have statistically significant. This shows ramus descendens anterior arteriae coronariae sinistrae classed IV causes obvious effect to heart function. For minute output, there is some different both between group4 and group1 and between group4 and group2. Thus the change in different part among myocardial mass, end-systole, end-diastolic left ventricular volume minute output and stroke output has no significant changes. Therefore we can conclude that same as grade IV stricture of coronary artery the pathology part near-end cause larger effect to heart function then middle-end and far-end.Conclusion: 1.The stricture of ramus descendens anterior arteriae coronariae sinistrae cause larger effect to heart function then right main coronary artery. So we can find pathological changes cause by the stricture of arteriae coronaria sinistra happen more frequently then other coronary embranchment. In consideration of its important parts of the blood supply to the left ventricle, once the vascular stricture or occlusion occurred, the left ventricular ejection function has a significant impact. Thus affect each parameter of heart function seriously. 2.grouping four team by stricture of simple ramus descendens anterior arteriae coronariae sinistrae. According to cardiac function statistical results of every group. We can see that it cause Serious impact to patients with stricture level IV. The most serious stricture is nearly occlusion. Impact the blood-supply and oxygen-supply, make cardiac muscle acute avascular necrosis, resulting in acute myocardial infarction; For mildly and moderately stricture of arteriae coronaria sinistra, Parameters of cardiac function indexes are better than the normal control group related indicators, consider it may be the compensatory changes of early lesions making the compensatory increase of myocardial function. 3.For the one who are in the same level IV stricture of ramus descendens anterior arteriae coronariae sinistrae. Grouping teams by the different part of stricture. We can see the near-end stricture of coronary artery cause significant impact based on statistical results, second is the middle and the weakest is the far. Consider the myocardial ischemia caused by near-end stricture of coronary artery is large, so is the effection of heart function. And the myocardial ischemia caused by far-end stricture of coronary artery is little, and so is the effection of heart function. |
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