Spray T L, Roberts W C
Circulation. 1977 May;55(5):741-9. doi: 10.1161/01.cir.55.5.741.
The status of the native coronary arteries at necropsy in the vicinity of the coronary anastomoses of saphenous vein aortocoronary bypass grafts in 20 patients with severe coronary heart disease is presented. Of the 37 graft systems (graft plus coronary artery into which graft inserted) analyzed, the lumina of 44% of the native coronary arteries within the first 2 cm distal to the anastomoses were greater than 75% narrowed in cross-sectional area by atherosclerotic plaques, and the native coronary artery at the site of the anastomosis was greater than 50% narrowed in cross-sectional area already by atheroclerotic plaque in 25% of the graft systems. The mean coronary arterial size distal to the site of the coronary graft anastomosis, even after correction for heart weight, was greater in the 13 men than in the seven women. The residual luminal areas squared per gram of heart weight, however, were similar in both men and women. These results suggest that 1) relative coronary vessel size is greater in men than women; 2) the luminal area squared per gram myocardial mass (a relative estimation of flow) is the same in the two groups of patients; and 3) less atherosclerotic plaque is necessary in women then in men to produce similar limitation to coronary flow. Thus, vessel size alone cannot account for the higher reported frequency of unsuccessful aortocoronary bypass procedures in women.
本文呈现了20例严重冠心病患者尸检时，隐静脉主动脉冠状动脉搭桥移植术冠状动脉吻合口附近的自身冠状动脉状况。在分析的37个移植系统（移植血管加上移植血管所植入的冠状动脉）中，吻合口远端前2厘米内的自身冠状动脉，有44%的管腔因动脉粥样硬化斑块导致横截面积狭窄超过75%，在25%的移植系统中，吻合口处的自身冠状动脉横截面积已因动脉粥样硬化斑块狭窄超过50%。即使校正心脏重量后，冠状动脉移植吻合口远端的平均冠状动脉大小，在13名男性中仍大于7名女性。然而，每克心脏重量的残余管腔面积平方在男性和女性中相似。这些结果表明：1）男性的相对冠状动脉大小大于女性；2）两组患者每克心肌质量的管腔面积平方（血流的相对估计值）相同；3）女性产生与男性相似的冠状动脉血流限制所需的动脉粥样硬化斑块较少。因此，仅血管大小不能解释报道中女性主动脉冠状动脉搭桥手术成功率较低的较高频率。
