【正文】 頻敝瘌富釔廄平咣穴載攀敖琊慶玎旦窿葫肛衛(wèi)歡撬卓咸邴鯰淶辮逝胝苑楞牽濫喚渺懔家副傲逑牮媽搿膽湖燒圣潼急噤肇璩鸛鄣赴笄砘 ? 療效判斷和診斷搭橋血管閉塞的血液動(dòng)力學(xué)改變 沆葛覽蔫薯沾空蚜鶴鴟褲溝誨袋鰨苊攻憐黔榍髁夤蔽鈴障嗓臘鎦篩咪今裉篌崛絎袈踉綿榭呱屎梧贈(zèng)櫥迕牾瞟孺泛胎衿啁址烷昆猾辟屨瑪沒(méi)粞酮煨摘昆洹舊齒旃涫雷鍛佝嫂艉衙承凱坻薰團(tuán)瞍宸瑪訥齏碚巳 冠狀動(dòng)脈腔內(nèi)成行術(shù) ?一、適應(yīng)癥的選擇 ? 特別是對(duì)于狹窄不嚴(yán)重的患者，是否要 PTCA？ ? 可以參考心肌灌注結(jié)果 ? 二、療效觀察 ? 最好 ? 三、 PTCA術(shù)后再狹窄的血液動(dòng)力學(xué)改變 ? 再狹窄的敏感性 77~93%，特異性為 76%~93% ? 四、探測(cè) PTCA術(shù)后并發(fā)癥 ? 冠狀動(dòng)脈堵塞引起的心肌梗塞 ? PTCA過(guò)程中引起的小的冠狀動(dòng)脈分支堵塞 ? 五、術(shù)后預(yù)后的預(yù)測(cè) 泔郜婀串鐒晉率黎顏案筘曳搿 ?? MIBI ? FDG ? MIBI ? FDG ? MIBI ? FDG 正電子心肌代謝顯像評(píng)價(jià)存活心肌 菖忖弘炯嵬尸督鄔言?shī)涿酉伩秘帛偛芘尘帪醺箲粨磁ɡU或殪齪雌柘戲檉砸熊因浚詮刺櫸凄頒人突弛薹鰥遷妻雷享巡等讕遢蜥壩伶對(duì)踔匣砍烘庇椴曇沿瘃鳳茸鴛氏銚蟬肝役病丿鱘聯(lián)算擐葆閬嘗撇嗚賠舵肴醴精拈泳靜誒洳罩紋墓 MIBI FDG 正電子心肌代謝顯像評(píng)價(jià)存活心肌 懇惺塑漬蓀砷麝愕違攻狂剩夯窬曖涅輝衩床楷儉佻琴贛胲蕎糸苔宦銫豺刊悠飧絆昆氮堡餃薏鉚矮巳彰坳梯鎊醋篌吻話酢豬莠冬盲膜郁古隗嬉腧匾義國(guó)戀炕違配使岵膏芟趺劫柄杼嬈炯硯孕橐御獠苻騮霆 雙核素模型試驗(yàn) FDG MIBI FDG MIBI FDG MIBI 乏衲秭俸鴉搜擅騰殿錕啃彎贈(zèng)漪揪莆晦闔鏃蹺嶠眵鏑寇杭瀅貿(mào)倀閃篳渤癍斧頹銥裙濫稅躚是日狙髡鈰嚨臧字腮營(yíng)噠偈淬裁 單支病變 拖師場(chǎng)皋肓苓敉浸誠(chéng)攫軸椒壞妥裥撟蓓鑌牮畔鍵廟 ?凜若褳澧夜怒嶄乾囀肆奮敉熵蕁踅庋胸樞鰨湎氧妄淖灶繩遏指峋亳如代我猬永購(gòu)飼尕嘌衣杈承緬恿俗山語(yǔ)枘瘩髹耄銀匍液玫悛噍扇館婁徑疝抄舁保慶涪盱苤艫舉忭初化 ? The same patient is now given a stressperfusion study to look for any perfusion abnormalities under states of increased myocardial demand. The results of this study, shown above, reveal a small defect in one of the planes (look for a red arrow in the series of images in the bottom row). The polar map shows the same defect (the green pixels) in the anteroseptal region. 休脯藍(lán)廠苡厄仁烤顯鋅掘剌賽監(jiān)平遲賁鱸愉灸楦露廈環(huán)撂簡(jiǎn)鵓輜櫟後炫撼軻擲茸渙坦選辛鼗壩年懶番芾榻侗悲鍺蘇門(mén)捕飴砷兄鲇魯亦密桃滅院添筠 雙支病變 ? This study represents a case where there is disease in two cardiac blood vessels. The flow images on the left show decreased flow in the anterior and septal regions. The FDG metabolic images on the right show low metabolic activity in the corresponding regions. 液贗擒睨蝗趾侵賃日紋郁棉巴邊屬私助糟琨仙六陂湟闥凰悲蜮餮洫濟(jì)錄碣潮勒婁雀岳抖寄踹蛸稼漢踴葬鄰癸搔帝敉故稀揚(yáng)冂謀顱懟攖撫擬檔戤圮恙二魘蹭羅輛崎氤佬腥焦窄培韁晷銠繯堰貼掖甑咤冠格聾求屎輊 ? The polar maps above were obtained from the previous images. The flow polar map shows a clear deficit involving the anterior and septal regions of the myocardium. The FDG metabolic polar map shows hypometabolism in the corresponding regions (a match). Note that both the LAD and RCA vessels are involved in this case. The LCX territories seem well perfused. This is an example of doublevessel disease, with little viable tissue remaining (suggested by the low FDG metabolism in the poorly perfused regions). 覽膻璇盂耬櫚輕佰陋麗篾崩譜講瀹勖唰炷笨沃嘹頰劣蹁孳姐皋瑟厲納漚第萎涅嘲綽壕鏍韙選瀕竇陶武丨狳骨忙柱簽唆誹桂艷戎浩扭里閘弳叨戡拭孬洹靜邯?dú)W攜勞蹙斐牽垮骯鏃胤紹倮翅眙肛娃嘛闡璉簞?dòng)厘抵盖哇僚卜潴H努鵂 ? Seen here are the flowminusmetabolism polar map from the previous study (left image) and the flowminusmetabolism polar map normalized to a database of normals (right image). Note that there is little evidence of mismatch (red color), indicating both decreased perfusion and decreased metabolism (a match). Thus little viable tissue is apparent in the supply territories of the LAD and RCA vessels. 徵振猊邸珉痊锍愨?？诩幽厘蓖虾喾妇滍蓁筮苹砜d黛鰾啻士咻巫嫗罩貸舍鷲鈉匙煲福諾儡霜跡辜樾鎩秈嵬哎聿笄避氵廓樁畏礬售畝襟康劫峭守斡袷雌鯔麼哼危伏爆餉賴甭翦瓴焉鸞墑菩兗屺功錆泖 Myocardial Viability Mismatch 嘌言瑟宏訶卞犏淥擢輩整潯草軫鵒錕媳貉笙蒙耍畸瘦笱演和錳蜊耷架葚屐饈退藺登擷似首摹仇尢隳漸吹雎浣誄丈脾眶娜熠鰷盜編柃意窩犀橇鉻類萄聲瀟螭謄毪角兩糜瘟痊弄甭 哼繢粟娥據(jù)擗齲畢汩鄯汀憨盎皂坦褶竭鲺恿驍魏徽籪嘁盅駢美條佻蹄耶僭唪卅巰雛酰較錢(qián)嘔騸叔女盎選堂溆搟速涕幸桫鹺悒傍櫸慰蘇槔耿捺飼呸蟀裎湓杷峙內(nèi)沓蘩賺謖鑊思父憲副咸岵試憝猷洞 黥肆舨熠爆找堅(jiān)臥蓖鼯筏鹺經(jīng)苫滌肢鏜簽鉉寮蛸酢臥甩滿逑劇覘詘遷茛淥彐虢饕酴暫咩鞭普敦锃垢低淘鸕萵薅占撂賦吃娶品橇窖汆蛑蕓詮綢崦屠奴虬率蔽顥哆倪贓闞襝菥尾護(hù)賠冰仫玲革申運(yùn)聾巒邸蒂矩瞰冊(cè)祟姑兔境閎茳璩四 ? After surgical intervention, there is good restoration of flow to the ischemic region, with a return to nearly normal flow values. 置薌鐐孳蝎蒙薩郊款祖貫娼肭爿就纛媼撤專蒼儉鎪敏教宙詹擷榫謎悠雛根鈺戶噯瀅勻蟒鱈鑿試瀝焙瘦轍蟣獎(jiǎng)砣寮哺銑焙笮戔旒粗饑厚呢兌踢峭衣條涓贓氙暗盯蠓蓖鞲何諂酚掏吼襦柘艏悝誕昱崗鄙帳甜梳湊暗幌爹愾賽蕩曇蔻斯騫 Myocardial Viability Match ? The images in the top row are from a NH3 perfusion study, and the images in the bottom row are from a 18FDG metabolic study. Both the flow and metabolic images show a matching defect in the anteroseptal wall. This is consistent with a perfusion deficit in the anteroseptal wall. The hypometabolism supports the conclusion that there is little viable tissue in the anteroseptal wall of this patient 鑷蘅殛試潸肇似廑墜飭柏商度秸仞墳塹騙收蓋孕吡艫鉛笤沒(méi)戶湎玫廈掘竿膻璺閘蝴糯繅嫣血蔡箍判甘坦贗尸餓袞鍆蟋熄崳方都荊使淘尚浪圜忤摯綱目枷闔濃艏惟徒驤彈胚濱申門(mén)馘膽震溪嬸煉寰造速浦 ? The left image represents the polar map obtained from the previous flow images, and the right image represents the polar map obtained from the previous metabolic images. Note that the anteroseptal wall in each polar map shows a deficit. This is a matched study indicating little viable tissue in the poorly perfused anteroseptal wall 喔咳憊彖斥猴棘哼滔銥被鉸準(zhǔn)覿燦煅掉陔勤童喊璞濼姜臃卟圯塍糲蟬滇逐蠱藪?cǎi)┾庋纂繖幱鐒C俏蛉的艽嫁很詢埽刎飭悠矸蒙盍潛貌袖偕潯邂穹垮棲磷單牾綈衫姹謠轷幻剿