The Clinic And Empirical Study Of Myocardial Contrast Echocardiography In Evaluating Blood Supply Of Ventricular Aneurysm Walls

Background and Objective Ventricular aneurysm(VA) is one severe complication of acute myocardial infarction.Because of thin infracted myocardium and degraded or deprivated systolic function,regional ventricle wall bulges.VA affects the left ventricular's function severely,so early diagnosis and effective treatment in time are very important for patient's prognosis.Along with the rapid growth of medical imaging technology,early diagnosis of VA is very accurate, UCG has became the preferred diagnostic method depending on many merits such as convenient,no wound and economy and so on.For the treatment of VA,the doctors always choose different methods based on the size of VA,expectant treatment is usually adopted for small VA,exairesis is usually adopted for big one, but the clinic has many disputes to indication and curative effect.Along with application of coronary artery disease intervention,people gradually realize that most of MI patients' dysfunctional myocardium has necrosis and survival myocardium(SM) together,the abnormal heart function becomes reversible due to the presence of SM.Effective revascularization in time could improve or restore SM's function and thereby improving the heart function.So,getting the message of SM's state of VA has significance to treatment and prognosis.MCE is a new technology about myocardial perfusion and function,the echo of myocardium is enhanced by minute air bubble's scattering effect,so that we could observe the myocardial perfusion and evaluate the myocardium microcirculation.Effective micrangium perfusion is necessary for SM,so MCE could identify SM indirectly and intuitively through myocardium micrangium perfusion.The research's object is utilizing MCE to VA patients to observe VA walls' imaging and identify the SM to explore the applied value of MCE in clinical treatment and prognosis of VA. Methods The research includes two parts:1,Animal experiments:Adopting traditional coronary artery ligation to produce VA models in 14 rarebits;after 2 and 4 weeks,rarebits are taken UCG and VA ones are selected to take MCE and we would observe the imaging of VA walls to identify SM in MCE,then we make VA walls of rarebits pathological sections to confirm whether they have SM or not.2,Clinical research:We select 21 VA patients in hospital diagnosed by UCG and confirmed by coronary arteriography.MCE is performed with Left elbow intravenous pellet infusion Sone Vue 2ml,we observe the process of constrast medium entering left ventricular and paying special attention to the image of VA wall and intima.Results 1,UCG discovered VAs in 6 rarebits after 4 weeks,left ventricle anterior walls(AW) and ventricular septurns become thin,wall thickening rate(WTR) and heart function are low,left ventricles expand and they respectively have statistics difference compared to preoperative measures.2,Rarebits' MCE show the process of constrast medium entering left ventricular and VA walls have sparse and inequable image.VA walls' pathological section confirm that part of myocardial cells vanish which replaced by fibrous tissues.3,21 VA patients' MCE:13 patients have uniform imaging,6 patients have sparse imaging,1 patient has weak imaging and 1 patient has no imaging,which correlated with coronary arteriography.4,The recognization of VA intima:before MCE,12 vague segments show clearly in MCE,the enhanced intima show 100%.Conclusions MCE could identify intima and SM in VA walls clearly through microcirculation perfusion and the imaging of VA is correlated with branch and level of stenotic coronary artery.MCE has important clinical value in providing objective and accurate guiding information for VA patients' treatment and prognosis.