Application Of Myocardial Contrast Echocardiography In The Interventional Treatment Of Chronic Coronary Occlusion

Chronic coronary occlusion is the occlusion of blood flow TIMI0 level before, while its blocking time is greater than or equal to 3 months of the lesions. High incidence of CTO lesions, accounting for detection of lesions in coronary angiography in all 1 / 5, because of its blood flow interrupted, myocardial serious, chronic ischemia, cardiac function under varying degrees of damage, resulting in limited patient mobility, high incidence of serious adverse cardiac events, and greatly affect quality of life. CTO lesion as early as possible has become an open clinical consensus. However, compared with non-occlusive disease, CTO lesions are often complex, the skill level of the patients who require high, intervention operation is difficult, supplies and more expensive, more complications and risks, the success rate is relatively low, and even certain mortality, and long-term restenosis and re-occlusion rate is relatively high, particularly because some patients no longer viable myocardium infarct zone, even if successful revascularization will not benefit from it. Therefore, how to carefully select the appropriate benefit from revascularization of CTO cases, the clinical problems to be solved. Currently, you can assess whether the survival of myocardial infarct area to estimate the value of open CTO. The motion abnormality but there were viable myocardial segments revascularization of myocardial function can be restored to varying degrees, with high therapeutic value; the other hand, no viable myocardium for the infarcted cases, the clinical significance of revascularization is not large. In recent years, myocardial contrast echocardiography in the detection of viable myocardium in the clinical begun to attract the attention of the role. MCE is a use of microbubble detection technology, these micro-bubbles remain after injection of vascular integrity, there will be no viable myocardium in the region. MCE can even detect the contraction stress test that there is no reserve but the survival of hibernating myocardium.Objective By myocardial contrast echocardiography in patient -s with chronic total occlusion of coronary artery before and after interventional procedures, analysis of myocardial contr -ast echocardiography in chronic coronary occlusion detection and evaluation of myocardial viability in patients with myoc -ardial perfusion value.Methods CTO respectively, and PTCA patients before and after stent implantation in myocardial contrast echocardiography and two-dimensional echocardiography, coronary revascularization according to two-dimensional echocardiography before and after the wall motion improvement in the standard or not, to judge Myocardial viability, myocardial contrast echocardiography assessment of sensitivity and specificity. Determination of myocardial perfusion by MCE rate (β), contrast agent intensity (A) and myocardial blood volume (A×β) and other indicators to assess myocardial perfusion improvement.Results 1, preoperative echocardiography was found in a total of 65 segmental wall motion abnormalities. After 1 month review of two-dimensional echocardiography, 48 segments that improved movement, movement of 17 segments without improvement. 2,16 cases of patients were successfully included in the analysis of myocardial contrast echocardiography, no adverse reactions occurred. Before surgery, choose the wall motion abnormalities were qualitative assessment of myocardial contrast echocardi -ography myocardial viability and found that 45 segments of viable myocardium, no viable myocardium in 20 segments. Myoca -rdial contrast echocardiography predict myocardial viability sensitivity, specificity and accuracy were 91.1%, 65%, 83.1%. 3,16 patients before and some filling defect filling defect in the 134 segments, 92 segments after filling to improve, no improvement in 42 segments, improve the rate of 68.7%. PTCA and stent implantation before surgery, perfusion improvement group and no improvement in perfusion group A,βand A×βvalues were lower than normal group (P <0.05). After 1 month, perfusion segments to improve the group A,βvalue and A×βsignif -icantly increased compared with the preoperative value (P <0.05), but no improvement in perfusion group A,βand A×βvalue of the value of no significant change (P > 0.05). Control group A,βand A×βvalue compared with the preope -rative values no significant change (P> 0.05).Conclusion This study shows that application of quantitative assessment of myocardial perfusion MCE to detect viable myoc -ardium, so that the level of detection become more accurate, objective and help to screen patients for appropriate CTO re -vascularization, so that patients benefit from it. MCE has checked the convenience, high resolution, non-invasive, non -radioactive, not half-life restrictions, reproducible and can be bedside, etc., which have greater clinical value. Compared with PET, MCE relatively inexpensive, yet the current level of China's economy is particularly suitable for under-developed application.