Takatsu F, Osugi J, Ozaki Y, Nagaya T
Department of Internal Medicine, Anjo Kosei Hospital, Aichi, Japan.
Jpn Circ J. 1988 Feb;52(2):169-74. doi: 10.1253/jcj.52.169.
To re-evaluate the concept of "high lateral" myocardial infarction, angiographic findings were analysed in 29 patients with remote infarction and abnormal Q waves in lead I or aVL but no abnormal Q waves in other leads and no prominent R wave in lead V1. All patients except one showed asynergy in the anterior segment on right anterior oblique left ventriculogram. Asynergies in other segments were, if present, mild or small. Critical narrowing was present in the diagonal branches or in their "parent" arteries (that is, the left anterior descending artery or left main trunk) in 28 patients but in the circumflex artery in only 3 patients. Thus, the traditional concept that a "high lateral" infarction is myocardial necrosis of the basal aspect of the left ventricle, receiving its blood supply from the circumflex artery, needs correction. "High lateral infarction" corresponds to necrosis of the area between the obtuse margin and the interventricular groove ordinarily supplied by the diagonal branches of the left anterior descending artery. Such infarctions are expressed by asynergy of the anterior segment rather than the posterior segment.
为了重新评估“高位侧壁”心肌梗死的概念，我们分析了29例陈旧性梗死患者的血管造影结果，这些患者在I导联或aVL导联出现异常Q波，但其他导联无异常Q波，且V1导联无明显R波。除1例患者外，所有患者在右前斜位左心室造影中均显示前壁节段运动不协调。其他节段的运动不协调（若存在）则较轻微或范围较小。28例患者的对角支或其“母”动脉（即左前降支或左主干）存在严重狭窄，而仅有3例患者的回旋支存在严重狭窄。因此，“高位侧壁”梗死是左心室基底部心肌坏死且由回旋支供血这一传统概念需要修正。“高位侧壁梗死”对应于通常由左前降支对角支供血的钝缘与室间沟之间区域的坏死。此类梗死表现为前壁节段运动不协调而非后壁节段运动不协调。
