Anjaneyulu Anne, Raghavaraju Penumatsa, Krishnaswamy Raghu, Johann Christopher, Krishnamraju Penmetcha, Rajagopalaraju Alluri, Somaraju Bhupathiraju
Division of Cardiology, Care Hospital, Hyderabad 500034, India.
J Am Soc Echocardiogr. 2005 Jun;18(6):686-92. doi: 10.1016/j.echo.2004.08.047.
Demonstration of recanalized coronary artery is mostly done by angiographic techniques. Early bedside demonstration of reperfusion after thrombolysis by transthoracic echocardiography (TTE) has important implications in the subsequent risk stratification and timing of coronary interventions.
In this study, 12 patients with acute anterior myocardial infarction who received thrombolytic therapy were studied. Echocardiographic Doppler evaluation of left main coronary artery, proximal left anterior descending coronary artery (LAD), and proximal left circumflex coronary artery were studied before, during, and after thrombolytic therapy. Coronary flow in these arterial segments was assessed both by color flow and velocity measurements. These results were compared with coronary angiographic studies performed within 30 minutes to 48 hours of thrombolysis.
Blood flow in left main coronary artery, LAD, and left circumflex coronary artery could be assessed in 9 patients. There was no demonstrable flow in LAD in 6 patients before thrombolysis. In 7 patients flow could be demonstrated in LAD after thrombolysis within 15 minutes to 6 hours. The peak flow velocity in LAD at a localized area of turbulence postthrombolysis varied from 1.8 to 4.5 m/s. One patient showed mosaic color flow in left main coronary artery with a peak velocity of 1.9 m/s before thrombolysis that improved to a laminar flow with a peak velocity of 1.0 m/s after thrombolysis. Two patients showed normal flow in proximal LAD, but no flow in mid-LAD. Two patients did not show any flow in LAD even after 12 hours of thrombolysis. There was good correlation of site of critical narrowing in LAD by TTE with coronary angiography in 6 patients. In 3 patients absent flow in mid-LAD by TTE correlated with total occlusion of either proximal (one patient) or mid-LAD (two patients).
Demonstration of recanalized infarct-related left coronary artery soon after thrombolytic therapy is feasible. Locating the actual site of critical narrowing at bedside by TTE has important implications in the subsequent treatment of patients with acute anterior wall myocardial infarction.
冠状动脉再通的显示大多通过血管造影技术完成。经胸超声心动图（TTE）在溶栓后早期床旁显示再灌注，对后续急性冠脉综合征患者的危险分层及冠状动脉介入治疗时机的选择具有重要意义。
本研究纳入12例接受溶栓治疗的急性前壁心肌梗死患者。在溶栓治疗前、治疗期间及治疗后，采用超声心动图多普勒评估左主干冠状动脉、左前降支冠状动脉近端（LAD）和左旋支冠状动脉近端。通过彩色血流和速度测量评估这些动脉节段的冠状动脉血流。将这些结果与溶栓后30分钟至48小时内进行的冠状动脉造影研究结果进行比较。
9例患者可评估左主干冠状动脉、LAD和左旋支冠状动脉的血流。6例患者在溶栓前LAD无明显血流。7例患者在溶栓后15分钟至6小时内LAD出现血流。溶栓后LAD局部湍流区域的峰值流速为1.8至4.5米/秒。1例患者在溶栓前左主干冠状动脉出现五彩镶嵌样血流，峰值流速为1.9米/秒，溶栓后改善为层流，峰值流速为1.0米/秒。2例患者LAD近端血流正常，但LAD中段无血流。2例患者即使在溶栓12小时后LAD仍无血流。6例患者TTE显示的LAD严重狭窄部位与冠状动脉造影结果具有良好的相关性。3例患者TTE显示LAD中段无血流与近端（1例患者）或LAD中段（2例患者）完全闭塞相关。
溶栓治疗后不久显示梗死相关左冠状动脉再通是可行的。通过TTE在床旁定位严重狭窄的实际部位，对急性前壁心肌梗死患者的后续治疗具有重要意义。
