论文部分内容阅读
目的研究心房颤动导管射频消融肺静脉电隔离术前左心房、肺静脉和食管16层螺旋CT成像技术及临床意义。资料与方法40例心房颤动患者在术前1~3天行多层螺旋CT(MSCT)检查,采用容积再现(VR)、多平面重组(MPR)及最大密度投影(MIP)等方法重组并测量各肺静脉口直径、左心房至肺静脉第一分支的距离、食管与左心房后壁接触的范围、食管壁厚度、左心房后壁厚度以及左心房与食管间的脂肪垫厚度。结果共显示肺静脉165支,右上肺静脉口前后径和上下径分别为(16.3±3.1)mm和(19.0±2.6)mm;右下肺静脉分别为(16.4±3.6)mm和(18.0±3.5)mm;左上肺静脉分别为(14.4±3.0)mm和(18.4±3.6)mm;左下肺静脉分别为(12.6±2.8)mm和(17.0±2.8)mm。食管与左心房后壁接触的平均长度为(56±12)mm,在双上、下肺静脉水平与左心房后壁接触的食管平均宽度分别为(10±5)mm和(14±5)mm。60%的食管位于左心房后壁中线偏左,大致与左上、下肺静脉口平行;40%的食管沿左上肺静脉向右下肺静脉斜行走行。左心房后壁和食管前壁的平均厚度分别为(2.2±0.8)mm和(3.5±1.6)mm。95%的左心房与食管间可见脂肪垫,其平均厚度为(0.8±0.2)mm。结论应用MSCT造影增强扫描可清楚显示各肺静脉口直径、分支特征、走行以及有无发育畸形,同时还能评价食管与左心房的关系,为心房颤动导管射频消融术的顺利实施提供重要解剖依据。
Objective To study the 16-slice spiral CT imaging of left atrium, pulmonary veins and esophagus before radiofrequency catheter ablation of atrial fibrillation and its clinical significance. Materials and Methods 40 patients with atrial fibrillation were examined by MSCT 1 to 3 days before surgery. The patients were reorganized and measured by volume reconstruction (VR), multiplanar reconstruction (MPR) and maximum density projection (MIP) The diameter of the pulmonary veins, the distance from the left atrium to the first branch of the pulmonary veins, the range of esophageal contact with the posterior wall of the left atrium, the thickness of the esophageal wall, the thickness of the posterior wall of the left atrium, and the thickness of the fat pad between the left atrium and the esophagus. Results A total of 165 pulmonary veins with a diameter of 16.3 ± 3.1 mm and a diameter of 19.0 ± 2.6 mm were found in the right upper pulmonary vein and a diameter of (16.4 ± 3.6) mm and (18.0 ± 3.5) mm in the lower right pulmonary vein respectively. Left superior pulmonary veins were (14.4 ± 3.0) mm and (18.4 ± 3.6) mm respectively; left inferior pulmonary veins were (12.6 ± 2.8) mm and (17.0 ± 2.8) mm, respectively. The mean length of esophagus contact with the posterior wall of the left atrium was (56 ± 12) mm. The average esophageal width at the level of the upper and lower pulmonary veins in contact with the posterior wall of the left atrium was (10 ± 5) mm and (14 ± 5) mm . 60% of the esophagus is located in the midline of the left atrial posterior wall to the left, roughly parallel to the left upper and lower pulmonary veins; 40% of the esophagus obliquely travels along the left upper pulmonary vein to the right lower pulmonary veins. The average thickness of the posterior wall of the left atrium and the anterior esophagus were (2.2 ± 0.8) mm and (3.5 ± 1.6) mm, respectively. 95% of the left atrium and esophageal visible fat pad, the average thickness of (0.8 ± 0.2) mm. Conclusions MSCT angiography can clearly show the diameter, branch characteristics, migration and developmental deformity of the pulmonary veins, as well as evaluate the relationship between the esophagus and the left atrium, and provide an important anatomic basis for the successful implementation of radiofrequency catheter ablation of atrial fibrillation.