Aintablian A, Hamby R I, Hoffman I, Weisz D, Voleti C, Wisoff B G
Am Heart J. 1978 Apr;95(4):429-40. doi: 10.1016/0002-8703(78)90233-8.
New postoperative electrocardiographic Q waves have been described in eight of 40 per cent of patients undergoing bypass grafting for coronary artery disease. Various theories have been proposed to explain these new Q waves. Correlations of new Q waves to vein bypass occlusion, prolonged pump time or aortic cross-clamping time are controversial. Indeed, whether or not the appearance of new postoperative Q waves means real transmural myocardial infarction is not clear. We report herein our experience with postoperative Q waves in 56 patients with vein bypass grafts and the relationship of new Q waves to ventricular venting, graft patency, and the postoperative ventriculogram. Our observations indicate that: (1) Not all Q waves are due to occlusion of the saphenous bypass grafts (as noted by others). (2) A certain percentage of new Q waves may not reflect true transmural myocardial infarction, especially when all the vein grafts are patent and the postoperative ventriculograms show improvement. (3) Some new Q waves reflect true transmural infarction due to occlusion of grafts or of distal coronary arteries with deteriorated left ventriculograms. (4) The high incidence of new Q waves in patients with ventricular vents is probably due to direct myocardial trauma at the apex of the left ventricle.
在接受冠状动脉疾病搭桥手术的患者中，40%的患者中有8例出现了术后新的心电图Q波。人们提出了各种理论来解释这些新的Q波。新Q波与静脉搭桥闭塞、体外循环时间延长或主动脉阻断时间之间的相关性存在争议。实际上，术后新Q波的出现是否意味着真正的透壁性心肌梗死尚不清楚。我们在此报告56例接受静脉搭桥手术患者术后Q波的情况，以及新Q波与心室排气、移植血管通畅情况和术后心室造影的关系。我们的观察结果表明：（1）并非所有Q波都是由于大隐静脉搭桥移植血管闭塞所致（如其他人所指出的）。（2）一定比例的新Q波可能并不反映真正的透壁性心肌梗死，尤其是当所有静脉移植血管通畅且术后心室造影显示改善时。（3）一些新Q波反映了由于移植血管或远端冠状动脉闭塞导致的真正透壁性梗死，且左心室造影结果恶化。（4）有心室排气装置的患者新Q波发生率高可能是由于左心室心尖部直接心肌损伤所致。
