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目的:利用CT三维成像技术研究心房颤动(房颤)患者行环肺静脉电隔离术(CPVA)前后肺静脉的形态学变化。方法:房颤患者共28例,行CPVA术(6.5±3.9)个月后进行随访,根据术后有无复发分为成功组(22例)和复发组(6例)。应用64排螺旋CT测量CPVA术前、后肺静脉口的径线、截面积、左心房容积,研究射频消融术后肺静脉的形态学特点并与术前做对比分析。结果:成功组术后左心房容积、左上肺静脉口最大径、右上肺静脉口最大径、右上肺静脉口最小径、右下肺静脉口最大径、右下肺静脉口最小径、4个肺静脉口截面积较术前缩小(P<0.05)。复发组术后仅见右下肺静脉口最大径、左下肺静脉口及右下肺静脉口面积较术前减少(P<0.05)。CPVA术后肺静脉的最大径及最小径狭窄率小于50%者分别为61.6%及56.3%;狭窄率50%～70%者分别为3.6%和5.4%。结论:(1)CPVA成功后可逆转房颤患者的肺静脉和左心房重构,而复发组未出现明显逆重构。(2)CPVA术后可引起部分患者无症状性肺静脉狭窄。
Objective: To study the morphological changes of pulmonary veins before and after circumferential pulmonary vein isolation (CPVA) in patients with atrial fibrillation (atrial fibrillation) by CT three-dimensional imaging. Methods: A total of 28 patients with atrial fibrillation were followed up for 6.5 ± 3.9 months after CPVA. According to the presence or absence of recurrence, they were divided into two groups: successful group (n = 22) and recurrent group (n = 6). The diameter, cross-sectional area and left atrium volume of the pulmonary vein before and after CPVA were measured by 64-slice spiral CT. The morphological characteristics of pulmonary veins after radiofrequency ablation were studied and compared with those before operation. Results: In the successful group, the left atrium volume, the maximum diameter of the left upper pulmonary vein, the maximum diameter of the right upper pulmonary vein, the minimum diameter of the right upper pulmonary vein, the maximum diameter of the right lower pulmonary vein and the diameter of the right lower pulmonary vein, Before shrinking (P <0.05). In the recurrence group, only the maximum diameter of the right lower pulmonary vein was observed, and the area of the left lower pulmonary vein and the right lower pulmonary vein was decreased compared with that before operation (P <0.05). The maximum diameter and the minimum diameter diameter of pulmonary veins after CPVA were 61.6% and 56.3% respectively, while those with stenosis rates of 50% ~ 70% were 3.6% and 5.4% respectively. CONCLUSION: (1) CPVA can reverse the remodeling of pulmonary veins and left atrium in patients with atrial fibrillation after successful CPVA, while no obvious inverse remodeling occurs in relapse group. (2) CPVA can cause asymptomatic pulmonary venous stenosis in some patients.