摘要
目的:探讨多层螺旋计算机断层摄影术(Multislice spiral CT,MSCT)对评价心房颤动(房颤)及非房颤患者左心耳形态学的临床应用价值。方法:对入选的86例患者分为房颤组44例为拟行导管消融治疗的阵发性房颤患者,对照组42例为无房颤的患者。所有患者经 MSCT 肺静脉成像检查,进行三维容积重建。测量左心耳容积、左心耳口长短径直径、左心耳与冠状动脉左回旋支的关系、左心耳嵴的长度及宽度。结果:房颤组患者左心房容积(119.8±33.4)ml、左心耳容积(10.1±4.8)ml、左心耳口面积(293.2±113.7)mm^2、左心耳口长短径(24.3±5.3)mm、(15.6±4.4)mm 均显著大于对照组,分别为:(89.6±29.2)ml,(7.5±3.1)ml,(221.5±87.6)mm^2,(20.8±3.8)mm 及(13.0±3.3)mm,有极显著性差异(P<0.005)。房颤组患者左心耳口面积自54.0 mm^2～502.4 mm^2不等,对照组为111.0 mm^2～566.6 mm^2不等。而两组中左心耳嵴的长度及宽度、左心耳基部同冠状动脉左回旋支的距离没有显著差别。结论:在房颤患者中,除了左心房的增大,左心耳容积及左心耳口面积也显著地增大,提示左心耳形态学的改变同房颤的发生密切相关。房颤患者左心耳口面积相差很大,术前评价左心耳口对选择封堵器及其型号很有帮助。另一方面,左心耳非常接近冠状动脉回旋支,基于左心耳基部消融时,应谨慎选择消融策略以避免损伤回旋支。MSCT 可作为测量及评价左心房、左心耳相关指标,明确左心耳周围组织结构的有效检查手段。
Objective： The aim was to assess the left atrial appendage （LAA）anatomic variations in patients with and without atrial fibrillation（ AF）by multisliee spiral computed tomography （MSCT） ,and describe the value of MSCT in the detection of LAA anatomy. Methods： Forthy-four patients with paroxysmal AF eandidated for catheter ablation and 42 controls without AF were enrolled in this study. Cardiac MSCT was used to analyze volume and ostium dimensions of LAA, relationship between LAA and left circumflex （LCX） coronary artery, and the length and width of LAA erista as well. Resuhs ： In patients with AF, the volume of LA （ 119. 8 ± 33.4 ） ml, the volume of LAA （ 10. 1-± 4. 8 ） ml, the area of LAA ostium （ 293.2 ± 113.7 ）mm2, and the long and short diameters （ 24. 3 ± 5.3 ） ram, （ 15.6 ± 4. 4 ）mm of LAA ostium were all significantly greater than those in control group [ （ 89. 6 ± 29. 2 ） ml, （ 7. 5 ± 3.1 ） ml, （ 221.5 ± 87. 6 ） mm^2, （ 20. 8 ± 3.8 ） mm and （ 13.0 ± 3.3 ）mm ; all P 〈 0. 005 ]. There was a great heterogeneity of LAA area from 54. 0 to 502. 4 mm^2 in AF patients, whereas that in control group was from 111.0 to 566. 6 mm^2. For the length and width of the LAA erista no significant difference was found between the two groups [ （ 24. 2 ± 4. 3 ） mm vs （ 19. 6 ± 3. 2 ） mm, （ 3. 8 ± 1.0 ） mm vs （4. 0 ± 1.2 ） mm ; all P 〉 0.05 ]. The distance between the LAA base and LCX in AF patients was 1.3 to 6.7 ram,similar to that of the controls [ （3. 6 ±0. 8） mm vs （3.4 ± 1.4）mm;P〉0.05]. Conclusion： Besides the enlargement of LA,the volume of LAA and the area of LAA ostium were significantly increased in AF patients. Preprocedural assessment of LAA ostium should be helpful for the selection of occlusion devices. Because LAA is be very close to LCX, the selection of AF ablation strategies should be carefully taken to avoid possible damage of LCX.
出处
《中国循环杂志》
CSCD
北大核心
2007年第6期440-443,共4页
Chinese Circulation Journal
关键词
左心耳
心房颤动
X线计算机断层摄影术
Left atrial appendage
Atrial fibrillation
X-ray computer tomography
