- 期刊
Revisiting Manifestations of Dipyridamole Stress/Redistribution 201Tl Myocardial Perfusion Imaging in Patients with Coronary Artery Fistula: A Report of Four Cases
再審視冠狀動脈瘻管病人Dipyridamole壓力／重分佈鉈－201心肌灌注造影的表現：四病例報告
摘要
文獻指出有冠狀動脈疼管及心絞痛的病人大部分在dipyridamole加壓之鉈－201心肌灌注造影上有灌注缺損。這些灌注缺損是可回復的或呈現反相重分布，機轉一般歸因於分流現象。我們提出四例有冠狀動脈瘻管及心紋痛的病人，其dipyridamole加壓之鉈－201心肌灌注造影呈現大部分非相應於冠狀動脈瘻管的灌注缺損。從1995到1999年在本院共有4例因心絞痛或冠狀動脈疾病的主要危險因子而接受dipyridamole加壓之鉈－201心肌灌注造影與冠狀動脈攝影檢查的病人被發現有冠狀動脈瘻管。這兩種檢查的時間間隔爲2週至一年。除了一例在左前降支冠狀動脈中段有瘻管與50-60%狹窄的病人在灌注造影的左心室心尖部有灌注缺損，其餘病人在有瘻管的冠狀動脈區域都沒有相對應的灌注缺損，即使併存有冠狀動脈狹窄或有雙重瘻管。我們的病例中有冠狀動脈瘻管及心絞痛的病人在dipyridamole加壓之鉈－201心肌灌注造影上呈現相對應灌注缺損的比例並不像過去報告的這麼高。在同一條血管上有冠狀動脈瘻管與狹窄的病人中其dipyridamole加壓之鉈－201心肌灌注造影沒有相應的灌注缺損並不罕見。進一步研究冠狀動脈瘻管的分流比例與dipyridamole加壓之鉈－201心肌灌注造影的表現的關係，分析dipyridamole引起的含瘻管的冠狀動脈區域相較於其他區域在血流動力學上的變化，並比較血管擴張劑相較於dobutamine或運動加壓的心肌灌注造影對於冠狀動脈瘻管的診斷力的差別也許會有進一步的發現。
並列摘要
Previous reports stated that patients with coronary artery fistula (CAF) and angina pectoris mostly had perfusion defects on 201Tl-myocardial perfusion SPECT with dipyridamole stress (dipyridamole 201Tl-MPI). These perfusion defects were reversible or of reversed redistribution patterns, and the mechanism was generally considered as steal phenomenon. Four patients with angina pectoris and major risk factors of coronary artery disease (CAD) undergoing dipyridamole 201Tl-MPI and coronary angiography (CAG) in our hospital from 1995 to 1999 were found to have CAFs. The durations between the two examinations were two weeks to one year. Except one case with 50%-60% of coronary artery stenosis and CAF in the middle segment of left anterior descending artery (LAD) had perfusion defect in the apical wall of left ventricle (LV) on MPI, all others did not have corresponding perfusion defect in the coronary territories with CAF, even if concomitant coronary stenosis or double CAF was present. The prevalence of corresponding perfusion defect on dipyridamole 201Tl-MPI in patients with CAF and angina pectoris in our series is not as high as previously reported. It is not rare for a patient with concomitant CAF and coronary stenosis in the same vessel to have no corresponding perfusion defect on dipyridamole 201Tl-MPI. Further studies to correlate shunt ratio of CAF with manifestations of dipyridamole 201Tl-MPI, to characterize dipyridamole-induced hemodynamic changes of the coronary territory with CAF relative to other territories, and comparing the diagnostic performances of vasodilator versus dobutamine or exercise stress MPI for CAF may be promising.
延伸閱讀
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