Zavadovskiĭ K V, Pan'kova A N, Lishmanov Iu B
Angiol Sosud Khir. 2010;16(2):31-5.
The present work was aimed at identifying the most informative parameters of perfusion pulmonoscintigraphy and radionuclide tomoventriculography in non-massive thromboembolism of the pulmonary-artery branches.
We examined a total of fifty-five patients. The Study Group was composed of 40 subjects (mean age 60.3 +/- 10.4 years) presenting with non-massive pulmonary artery thromboembolism (PATE). The Comparison Group comprised 15 patients with coronary heart disease (CAD) (average age 59.0 +/- 9.0 years, NYHA functional class I-IT circulatory insufficiency). All patients were subjected to perfusion-ventilatory pulmonoscintigraphy and radionuclide equilibrium tomoventriculography. The basic systolic and diastolic parameters of the right ventricle (RV) were determined using the obtained
The Group of patients with non-massive PATE (i. e., damage to the pulmonary vascular bed up to 50%) turned out hypertension. quite heterogeneous by the severity degree of the RV contractility dysfunction. This Group included the patients with and without signs of RV contractility dysfunction. Taking into consideration small extension of the lesion, normal values of functional capability of the right portions of the heart may be interpreted as a sign of acute PATE, whereas the presence of pronounced systolicdiastolic dysfunction of the right ventricle should be regarded as apathognomonic sign of chronicpost-thromboembolic pulmonary hypertension.
The most informative scintigraphic signs of right-ventricular dysfunction in thromboembolism of the pulmonary-artery branches are as follows: a decrease in the RV stroke volume, peak ejection rate and filling rate which are revealed even in insignificant embolisation of the lesser-circulation vessels. The preserved functional ability of the right portions of the heart in patients with a small scope of damage to the vascular bed of the lungs may be regarded as a sign of acute thromboembolism, while systolic-diastolic dysfunction of the right ventricle as one of the indices of chronic post-thromboembolic pulmonary hypertension.
本研究旨在确定灌注肺闪烁扫描和放射性核素断层心室造影在肺动脉分支非大面积血栓栓塞中最具信息价值的参数。
我们共检查了55例患者。研究组由40名患有非大面积肺动脉血栓栓塞（PATE）的受试者组成（平均年龄60.3±10.4岁）。对照组包括15例冠心病（CAD）患者（平均年龄59.0±9.0岁，纽约心脏协会心功能分级为I-II级循环功能不全）。所有患者均接受了灌注通气肺闪烁扫描和放射性核素平衡断层心室造影。使用所获得的结果确定右心室（RV）的基本收缩和舒张参数。
非大面积PATE患者组（即肺血管床损伤高达50%）的右心室收缩功能障碍严重程度差异很大。该组包括有和没有右心室收缩功能障碍迹象的患者。考虑到病变范围较小，心脏右部功能能力的正常值可被解释为急性PATE的迹象，而右心室明显的收缩舒张功能障碍应被视为慢性血栓栓塞后肺动脉高压的特征性体征。
肺动脉分支血栓栓塞中右心室功能障碍最具信息价值的闪烁扫描征象如下：右心室每搏输出量、射血峰值率和充盈率降低，即使在小循环血管轻微栓塞时也会出现。肺血管床损伤范围较小的患者心脏右部保留的功能能力可被视为急性血栓栓塞的迹象，而右心室收缩舒张功能障碍是慢性血栓栓塞后肺动脉高压的指标之一。
