A case of coronary artery bypass grafting for single coronary artery complicated by angina pectoris

A case of coronary artery bypass grafting (CABG) for single coronary artery complicated by angina pectoris (AP) was reported. The patient was a 74-year-old male, complained of anginal discomforts. His single coronary artery originated in left coronary sinus, bifurcated to the left anterior descending artery (LAD) and the circumflex artery (CX), and then, an abnormal communicating branch, passing in front of the right ventricular outflow, was branched from the proximal region of LAD; it showed a route corresponding to the proximal region of the right coronary artery (RCA). The distal region of RCA and the posterior descending artery were angiographed in continuity from CX. Other findings included 75%-stenosis at LAD-#6 and 90%-stenosis at CX-#13. Using two saphenous vein grafts, CABG operation was carried out on those regions at LAD-#7 and distal CX corresponding to #3 normally. Postoperatively, anginal discomforts disappeared, and favorable results were obtained.     

Computer-assisted imaging of embryonic and fetal development. Background, recommendations and overview

A 65 year-old white man, with typical angina pectoris, underwent coronary angiography that showed dual left anterior descending artery (LAD), originating from the right coronary artery (RCA), associated with anomalous origin of the left circumflex artery (LCX) also from the RCA. This an extremely rare coronary artery anomaly and, it is the first case reported, so far. This rareness and clinical significance are emphasized.     

The effects of pictorial versus tangible stimuli in stimulus-preference assessments

OBJECTIVES: The purpose of this study was to compare 3-year risk-adjusted survival in patients undergoing coronary artery bypass graft (CABG) surgery and percutaneous transluminal coronary angioplasty. BACKGROUND: Coronary artery bypass graft surgery and angioplasty are two common treatments for coronary artery disease. For referral purposes, it is important to know the relative pattern of survival after hospital discharge for these procedures and to identify patient characteristics that are related to survival. METHODS: New York's CABG surgery and angioplasty registries were used to identify New York patients undergoing CABG surgery and angioplasty from January 1, 1993 to December 31, 1995. Mortality within 3 years of undergoing the procedure (adjusted for patient severity of illness) and subsequent revascularization within 3 years were captured. Three-year mortality rates were adjusted using proportional hazards methods to account for baseline differences in patients' severity of illness. RESULTS: Patients with one-vessel disease with the one vessel not involving the left anterior descending artery (LAD) or with less than 70% LAD stenosis had a statistically significantly longer adjusted 3-year survival with angioplasty (95.3%) than with CABG surgery (92.4%). Patients with proximal LAD stenosis of at least 70% had a statistically significantly longer adjusted 3-year survival with CABG surgery than with angioplasty regardless of the number of coronary vessels diseased. Also, patients with three-vessel disease had a statistically significantly longer adjusted 3-year survival with CABG surgery regardless of proximal LAD disease. Patients with other one-vessel or two-vessel disease had no treatment-related differences in survival. CONCLUSIONS: Treatment-related survival benefit at 3-years in patients with ischemic heart disease is predicted by the anatomic extent and specific site of the disease, as well as by the treatment chosen.     

Percutaneous coronary angioplasty of radial artery conduits

The higher long-term patency of internal mammary artery grafts has stimulated the search for alternative conduits in order to achieve a complete arterial myocardial revascularization. Percutaneous angioplasty is often the preferred strategy for the treatment of recurrent ischemia in patients who previously underwent bypass surgery, but there is limited experience in the treatment of arterial grafts. We describe two cases of percutaneous treatment of diseased radial artery (RA) grafts. In the first case, two disarticulated stents were deployed through an RA graft: half stent inside the anastomosis to the left anterior descending (LAD) artery, and half stent in the distal LAD artery. Diffuse spasm of the RA graft, resistant to ic nitrates, was successfully reversed after ic calcium antagonists. Absence of restenosis was confirmed two years later. In the second case, after simultaneous catheterization of both the left coronary artery and RA graft, two long stents were implanted in the LAD artery and a final "reversed" kissing-balloon dilation through the stent struts was performed; four months later the patient showed proximal occlusion of the LAD artery and the stenotic RA distal anastomosis was successfully dilated.     

Antibodies to prothrombin in antiphospholipid syndrome and inflammatory disorders

The ability to noninvasively assess the patency of coronary stents would represent a significant advance. We evaluated the safety and ability of two-dimensional coronary MR angiography in imaging stents and suggesting patency. Coronary MR angiography of 26 coronary stents (Palmaz-Schatz) was performed in 16 patients 39 to 73 years of age. Studies were performed between 2 and 4 months after stent placement. All patients were symptom free at the time of imaging. Coronary MR angiography was performed with a commercial 1.5-T MR imager using an electrocardiographically gated pulse sequence with breath-holding. Images were obtained in mid-diastole with and without fat suppression. Image artifacts caused by the metal in the stents were clearly visualized in all 26 stents (100% sensitivity for stent detection). Arterial flow signal was seen in the coronary artery or graft distal to the stent in 25 of 26 cases (96%). All patients, except for the one in which distal flow could not be seen, remained symptom free for >2 years. The distribution of stent locations was as follows: 10 in the right coronary artery (RCA), 10 in the left anterior descending coronary artery (LAD), 2 in the left circumflex coronary artery, and 4 in saphenous vein grafts (SVGs) to RCA. One patient had 2 RCA and 2 LAD stents, one had 3 RCA and 1 LAD stents, one had 3 SVG stents, and two had double RCA stents. Coronary MR angiography is safe for noninvasive imaging of coronary stents, and in the proper clinical setting, it can be used to help suggest patency.     

Sudden unexpected death resulting from an anomalous hypoplastic left coronary artery

We present a case of sudden death in a 24-year-old, healthy white female who was physically active and participated in sports, including soccer. Two weeks prior to her death, an insurance physical examination revealed an abnormal electrocardiogram which demonstrated flipped T waves in the anterior leads. There was no other remarkable medical history. At autopsy, only one coronary ostium was demonstrated and it originated from the right aortic sinus. Approximately 0.8 cm from this right coronary artery (RCA) ostium, a left coronary artery (LCA) branched off the RCA at a 90-degree angle. The LCA had luminal diameter of 0.4 m but the LCA had a luminal diameter of only 0.1 cm. The LCA coursed anterior to the base of the pulmonary artery and down the anterior ventricular septum reflecting the usual course of the left anterior descending (LAD) coronary artery. The LCA and RCA paths appeared to merge or terminate at the anterior left ventricular myocardium which was discolored gray, a process that involved the inner and middle thirds of the myocardium. Based on the autopsy findings, we certified the cause of death as a probable arrhythmia due to myocardial fibrosis and dystrophic calcification resulting from complications of an anomalous hypoplastic left coronary artery. Anomalies of coronary arteries have been classified and studied at autopsy and by clinical angiography. Coronary artery anomalies can be divided into minor and major forms with major anomalies often resulting in cardiac dysfunction that may cause failure and death. Minor anomalies, in general, have no pathophysiological significance and are compatible with life. Minor anomalies include variations in number and location of coronary ostia. A single coronary ostia is exceedingly rare in hearts with no other congenital malformations. The prognostic significance can be unpredictable. A single coronary artery has the potential to be dangerous if obstructed at its main stem, or if it branches at an acute angle. Additionally, hypoplasia of one or more coronary arteries has been found to be associated with sudden death.     

Reverse redistribution during dipyridamole thallium-201 myocardial single photon emission computed tomography in coronary artery disease

Ninety-six of the consecutive 1100 patients who underwent dipyridamole thallium-201 myocardial single photon emission computed tomography (SPECT) demonstrated reverse redistribution (RR). Twenty-six of the 96 cases who had accepted coronary angiographies were included in this study. RR was present in 40 myocardial segments from the 26 patients. Seventeen segments were in the right coronary artery (RCA) distribution, 17 in the left anterior descending artery (LAD) distribution, and 6 in the left circumflex artery (LCX) distribution. Perfusion defects noted on the initial study became more severe in the delayed images in 22 segments and normal perfusion was present during the initial images in 18 segments. Seventeen segments with RR were in the distribution of coronary arteries with abnormal angiographic findings. Of the remaining 23 segments, the angiographic findings were normal. In conclusion, RR can happen in TI -201 SPECT after dipyridamole and easily appears in the territories of RCA and LAD. It does not absolutely indicate whether the arteries are significantly diseased or normal coronary arteries.     

Acute myocardial infarct caused by a muscle bridge of the anterior interventricular ramus: complicated course with vascular perforation after stent implantation

A 47-year-old male patient was admitted to our hospital with acute anterior myocardial infarction. Immediate coronary angiography was carried out, which showed proximal occlusion of the left anterior descending artery (LAD). After mechanical recanalization, a reduction in vessel caliber at the site of occlusion was visible, and balloon angioplasty with consecutive stent implantation because of vessel wall dissection was performed. After the procedure, diameter reduction of the entire vessel segment distal to the stent and muscular bridging with subtotal systolic obliteration of the LAD and one diagonal branch were demonstrated. Diastolic coronary flow did not appear to be limited (TIMI 3). Dipyridamole-thallium cardiac imaging revealed an incomplete perfusion defect of the anteroseptal region and a reversible perfusion reduction of the anterolateral region. For definitive treatment, we decided to implant a 3.0 mm-stent at the site of muscular bridging. Although balloon sizing was adapted to the diameter of the proximal reference segment, measured by quantitative coronary angiography, coronary perforation into the right ventricular outflow tract due to balloon oversizing in the distal dilation segment occurred. The patient remained asymptomatic at rest as well as under exercise testing, and hemodynamics remained stable. Coronary re-angiography after 1 week demonstrated a persistent fistula with complete opacification of the LAD and normal coronary flow (TIMI 3). Within the following 3 months, the coronary fistula closed spontaneously. CONCLUSIONS: Muscular bridging is a rare cause of acute myocardial infarction. Balloon angioplasty and stent implantation in the bridged segment may be complicated by coronary artery perforation due to balloon oversizing. Risks and benefits of this therapeutic option, therefore, have to be critically evaluated, and careful selection of balloon size using measurements of proximal and distal reference diameter assessed by intravascular ultrasound is recommended. Coronary artery perforation into the myocardium with subsequent development of a fistula may be treated conservatively as long as the patient remains asymptomatic. The frequency of spontaneous closure of the fistula is high.     

The emerging role of MIF in septic shock and infection

A case of successful patch angioplasty for the right coronary artery (RCA) orifice dissection following selective coronary perfusion is reported. A 56-year-old woman who had mitral restenosis, aortic stenosis, and atrial fibrillation with bradycardia-tachycardia syndrome was referred to our hospital for operation. The operation, which contained aortic valve replacement and mitral commissurotomy, was performed with hypothermic cardiopulmonary bypass and crystalloid cardioplegic arrest. The ascending aorta was opened, and selective coronary perfusion was performed. The right coronary cannula was difficult to insert and dislodged several times. At the second infusion of the cardioplegic solution, the right coronary orifice and ascending aortic wall was dissected. The dissection extended to the proximal RCA. The aortotomy was extended into the RCA beyond its orifice. The Xenomedica pericardial patch was used to enlarge the diameter of the RCA with closing the dissected cavity. Then the patch was brought onto the side of the aorta and the aortotomy was closed in the usual manner. Post operative coronary angiography revealed widely patent RCA orifice and good runoff. Two years after operation the patient is free of angina with unlimited physical activity.     

Factors contributing to retinal detachment after transscleral fixation of posterior chamber intraocular lenses

Coronary arteries are segmented from the blood pool using mathematical morphology operations from a 3D magnetic resonance spiral acquisition on a continuously breathing healthy volunteer. The segmented volume is maximal intensity projected at different views to yield coronary angiograms showing the left anterior descending artery (LAD), right coronary artery (RCA), and left circumflex artery (LCX). Magnetic resonance coronary angiography provides a retrospective rotating view of the coronary artery tree that complements oblique reformatted sections.     

Coronary endarterectomy revisited: mid-term angiographic results

OBJECTIVES: To evaluate the value of concomitant coronary endarterectomy (CE) in the modern era of coronary revascularization. METHODS: Retrospective study. Twenty-eight patients (five women; 23 men) who underwent coronary endarterectomy were angiographically studied 24 +/- 22 months after the procedure. Necessity CE (vessel completely occluded or with lumen less than 1 mm) was performed on the left anterior descending (LAD) artery in 12 patients, the right coronary artery (RCA) in nine, the obtuse marginal artery (OM) in five and a diagonal branch in two patients. Conduits used for revascularization were the internal thoracic artery (ITA) in 11 (all anastomosed to the LAD; combined with saphenous vein patch in four) and a saphenous vein graft in 17 patients. Mean atherosclerotic core length was 3.3 +/- 1.8 cm. An average of 3.1 +/- 0.7 distal anastomoses per patient were constructed, with mean aortic cross-clamp and cardiopulmonary bypass times of 61.2 +/- 20.2 mins and 94.0 +/- 23.5 mins, respectively. RESULTS: Overall, angiographic patency rate was 71% (20 of 28) for the endarterectomized vessels (12 of 12 LAD, six of nine RCA, two of five OM and none of two diagonal arteries) and 93% (57 of 61) for the nonendarterectomized vessels. Among the eight patients with occluded CE vessels, two sustained a perioperative myocardial infarction, five developed angina during follow-up, and one patient remained asymptomatic. CONCLUSION: Necessity CE demonstrates acceptable mid-term patency. In addition, this study showed excellent patency following CE of the LAD revascularized with the ITA, with or without only a saphenous vein patch.     

Age specific prostate specific antigen reference ranges: population specific

BACKGROUND: Anastomosis of the left internal thoracic artery to the left anterior descending artery without sternotomy and without cardiopulmonary bypass is a standard approach in minimally invasive coronary artery bypass grafting. To expand the indications for minimally invasive coronary artery bypass grafting from one-vessel disease to two-vessel disease, we began to perform anastomosis of the right gastroepiploic artery (RGEA) to the right coronary artery (RCA). METHODS: From February to November 1996, an RGEA graft was used in 25 of the 100 patients who underwent minimally invasive coronary artery bypass grafting at our clinic. Eleven of the patients had only RCA disease and 14 had both RCA and left anterior descending artery disease. One of the operations was a redo coronary artery bypass grafting. The RGEA was anastomosed to the RCA through a laparotomy incision and the left internal thoracic artery was anastomosed to the left anterior descending artery through a left anterior thoracotomy. In 5 patients, the RGEA was lengthened by venous grafting. RESULTS: All patients underwent angiography after operation; 82.6% of the RGEA grafts and all the left internal thoracic artery grafts were functioning well. In three of the four nonvisualized RGEA grafts, the percentage of proximal stenosis of the RCA seen on postoperative angiography was not critical (40%, 50%, and 50%, respectively), allowing significant competitive flow through the native bypassed RCA. The patency of all the RGEA grafts without competitive flow was 95%, with a 95% confidence interval of 75.1% to 99.9%. CONCLUSIONS: The indications for minimally invasive coronary artery bypass grafting could be extended to primary operations in patients with left anterior descending artery and RCA lesions by using both the left internal thoracic artery and the RGEA.     

Morphometric analysis of CD4+, CD8+, and gamma/delta+ T-lymphocytes in lymph nodes of cattle vaccinated with Brucella abortus strains RB51 and 19

We have often experienced false positive results of the stress Thallium-201 myocardial scintigraphy (TL) for the evaluation of artery bypass graft patency after coronary artery bypass surgery (CABG). The purpose of this study is to clarify the frequency and the clinical significance of this findings. Sixty-two patients undergoing coronary angiography (CAG) after CABG were studied. These patients had undergone at total of 156 bypasses (artery grafts 108, saphenous vein grafts 48, mean bypass grafts number 2.65/cases), and the mean period from CABG to TL was 41.6 +/- 34 days. The territories of stress induced ischemia were divided into 3 territories; left anterior descending (LAD), right coronary artery (RCA), and left circumflex (LCX) territories. Patency of the bypass grafts was estimated on the absence of transient perfusion defect (TPD) on TL images. The incidence of false positive results was higher in Dipyridamole TL (38%) than in Exercise TL (18%) and higher in LAD territories (38%) than in RCA (11%) and LCX (13%) territories. All false positive cases showed no evidence of chest pain and significant ST-T change during stress TL test. High incidence of false positive results of stress TL test was observed for the evaluation of artery bypass graft patency after CABG.     

Serum enzyme abnormalities in protein energy malnutrition

A semi-quantitative right coronary artery score (RCA score) was derived from the ratio of the number of the major left ventricular branches of the right coronary artery to the total of the right coronary and left circumflex arteries, to stratify the extent of perfusion in patients with right coronary artery dominance. Thirty-seven patients with one-vessel coronary disease involving a dominant right coronary artery proximal to the left ventricular branches were selected for study. Thallium scintigraphy was performed after right intracoronary injection in 11 patients, and 26 patients underwent conventional stress thallium scintigraphy (24 exercise thallium and two dipyridamole thallium scintigraphy). Thallium scores of perfusion region size after right intracoronary thallium injection and perfusion defect size in stress thallium studies were quantitated from planar thallium images. Both the RCA score and the regional thallium scores spanned over a wide range. The RCA score (range 0.23-0.85) correlated best with the posterior (70 degrees left anterior oblique view) plus lateral segment (40 degrees left anterior oblique view) thallium score (r = 0.88 and 0.53 for intracoronary and stress thallium studies respectively). It also correlated with the summed thallium scores in the posterior, lateral, apical and inferior segments (r = 0.73 and 0.54 respectively) but not with thallium scores in the apex or inferior segment alone. The proposed RCA score quantitates the variable posterolateral perfusion territory of the right coronary artery, and could stratify the area of myocardium at risk from coronary stenosis in the majority of patients with right coronary dominance.     

The logo of the Italian Society of Hygiene between Mercury and Aesculapius: revisiting history]

The objective of this study was to evaluate the relationship between human coronary artery distensibility and vessel wall morphology assessed by histomorphometry. Coronary artery pressure-cross-sectional area relations and distensibility were studied in excised autopsy hearts by means of a balloon-based impedance planimetric technique 2 cm from the aortic orifice of the arteries. Later the hearts were perfusion fixed at 100 mm Hg and cross-sectioned 17, 20 and 23 mm distal to the aortic orifice. The areas of lumen, intima and media were measured. Nineteen left anterior descending coronary arteries (LAD) and 15 right coronary arteries (RCA) from 25 hearts (12 women and 13 men) were investigated. The age of the subjects was 48-97 years (mean 73.8 years). Non-linear relations were found between balloon pressure and coronary cross-sectional area (according with the function y = a + bx0.5) and between balloon pressure and coronary distensibility, but there were no differences in these relations between the LAD and RCA. Subjects' age was positively correlated with wall thickness (r = 0.44, P < 0.05), intima area (r = 0.46, P < 0.01) and media area (r = 0.44, P < 0.05) of the coronary arteries. Additionally, the distensibility at low pressures was inversely correlated with arterial wall thickness (r = -0.37, P < 0.05). When focusing only on arteries with concentric atherosclerotic lesions, distensibility at low pressures was inversely correlated with arterial wall thickness (r = -0.57, P = 0.01) and intima area (r = -0.53, P < 0.05). Arteries with concentric lesions were less distensible at low pressures compared with arteries having eccentric lesions (5.4 +/- 0.8.10(-2) vs. 3.6 +/- 0.7.10(-2) kPa-1, P < 0.05) but this difference was absent at higher pressures. No difference in coronary artery distensibility was found between men and women. Age and distensibility were not correlated. These findings may have in vivo implications for complications to angioplasty procedures such as recoil and restenosis.     

Relationships between left ventricular mass, left ventricular work and coronary artery size in aortic regurgitation--possible mechanism of myocardial ischemia

To investigate the relationships between coronary artery size, left ventricular (LV) mass, and LV stroke work in aortic regurgitation (AR), these values were measured in 19 patients with severe AR. Twenty normal subjects and 15 patients with mitral regurgitation (MR) were used as control groups. The coronary area index, i.e., the coronary cross-sectional area divided by body surface area (BSA), was larger in the AR group than in the control groups in all measured sites except for the peripheral left anterior descending coronary artery (LAD) and right coronary artery (RCA). However, the coronary area index divided by the LV mass was significantly smaller in AR and MR patients than in normal subjects. Furthermore, the coronary area index divided by LV stroke work was smaller in AR patients than in MR patients and normal subjects. These results suggest that the coronary blood flow associated with the increased LV mass and stroke work caused by regurgitation was insufficient in patients with severe AR, especially in the area of the LAD. Therefore, the occurrence of myocardial ischemia in patients with severe AR may involve inadequate enlargement of the coronary artery which perfuses the LV, in addition to factors such as decreased coronary perfusion pressure, increased coronary artery resistance and decreased coronary flow reserve.     

Coronary occlusion site as a determinant of the cardiac rhythm effects of atropine and vagotomy

We have previously demonstrated that atropine pretreatment increases the incidence of fatal ventricular arrhythmias induced by left anterior descending coronary artery (LAD) occlusion. The purpose of the present study was to determine whether the deleterious effect of atropine also applies to arrhythmias induced by right coronary artery (RCA) occlsusion. Occlusion of the RCA resulted in ventricular arrhythmias in all 20 animals studied, followed by ventricular fibrillation in three animals (15 per cent). Right coronary occlusion also resulted in bradycardia (-30.3 +/- 5.1 beats per minute) and hypotension (-23.1 +/- 4.9 mm. Hg). Pretreatment of 15 animals with atropine caused no significant increase in the incidence of ventricular fibrillation (i.e., 20 per cent). In addition, atropine pretreatment had no effect on the fall in heart rate and hypotension associated with RCA ligation. Sectioning the vagus nerves produced results similar to atropine pretreatment with the exception that a significant portion of the bradycardia was prevented. These results indicate that the increase in deaths after atropine observed in animals undergoing experimental LAD occlusion in not demonstrated with RCA occlusion. The results also indicate that the potential for deleterious effects of atropine in acute infarction might depend on the anatomic location of the involved myocardium.     

Third angioplasty, and after that?

The authors studied retrospectively a series of 39 patients with a documented second restenosis after coronary angioplasty between January 1987 and November 1992, 33 of whom (31 men, 2 women) underwent a third procedure. The artery dilated was the left anterior descending (n = 17 including 9 proximal stenoses), the right coronary (n = 10), the left circumflex or its branches (n = 5) and the left main stem (n = 1). The lesions were confirmed to one vessel in 25 cases (75%) and affected two vessels in 8 cases (25%). The third angioplasty procedure was performed on a single artery in all cases. The average left ventricular ejection fraction was 60% (43%-75%). The diameter of the dilated artery was over 3.25 mm in 24% of cases (8/33). The primary success rate was 100% without any complications. The average period between the first and second angioplasties was 16 +/- 10 weeks, and between the second and third angioplasties 19 +/- 12 weeks. Angioplastic controls of the 3rd angioplasty were performed in 25 cases (75%). A third restenosis (n = 7) was treated by surgical bypass (n = 1), repeat angioplasty (n = 4), endocoronary stenting (n = 1) or medically (n = 1), with a global follow-up of 22 months (2-56 months), 2 patients underwent coronary bypass grafting, 2 have residual angina (contralateral lesion which could not be dilated), 1 had an infarct in the territory of an undilated artery, and 28 (85%) were asymptomatic. The restenosis rate after the third angioplasty procedure was 28% (7/25).(ABSTRACT TRUNCATED AT 250 WORDS)     

CABG after patch angioplasty of the left main coronary: artery report of a case

A 57-year-old man was admitted to our hospital because of restenosis of the left main coronary trunk (LMT) after patch angioplasty for the LMT lesion. PTCA was repeated four times during three years after patch angioplasty, but recent coronary angiogram still demonstrated 75% restenosis of the LMT lesion. Double-CABG was performed to LAD and LCX using the left internal thoracic artery and saphenous vein graft. Postoperative coronary angiogram revealed an excellent result. A careful consideration must be given to the indication of the patch angioplasty of the LMT lesion.     

New electrocardiographic criteria for predicting the site of coronary artery occlusion in inferior wall acute myocardial infarction

In patients with inferior wall acute myocardial infarction (AMI), the site of the culprit lesion is an important determinant of outcome. Patients with right ventricular infarction have a poor prognosis, whereas those with occlusion of the left circumflex coronary artery (LCx) have a good prognosis. Therefore, we assessed whether standard 12-lead electrocardiograms obtained on admission could identify the site of coronary artery occlusion, (i.e., a site proximal to the origin of the right ventricular branch of the right coronary artery [RCA], a site distal to the origin of the right ventricular branch of the RCA, or a site in the LCx). The ratio of ST depression in lead V3 to ST elevation in lead III (V3/III ratio) was evaluated immediately before coronary angiography in 152 patients with a first inferior wall AMI confirmed by coronary angiography within 12 hours after the onset of symptoms. For occlusion of the proximal RCA, distal RCA, and LCx, V3/III ratio was 0.2+/-0.3, 0.8+/-0.5, and 2.5+/-2.5 (p = 0.0001), respectively. The V3/III ratio <0.5 identified proximal RCA occlusion, 0.5 相似文献