摘要
目的评价多层螺旋CT(MSCT)在肺静脉成像中的应用价值。方法实验组60例,均为阵发性心房颤动(房颤)患者,无器质性心脏病或仅合并高血压病；房颤发作频繁,症状重,药物治疗无效；电生理检查提示为肺静脉起源。30例肺静脉射频导管消融术术前行MSCT检查,其中13例术后3个月行MSCT检查；其余30例仅于术后3～18个月行MSCT检查。对70根肺静脉的选择性肺静脉造影结果及MSCT检查结果进行比较。对照组60例,均为非房颤患者,合并冠心病和/或高血压病,均行MSCT检查。结果肺静脉造影测量左上肺静脉30根,平均直径(18．39±5．02)mm；右上肺静脉30根,平均直径(17．97±4．89)mm；左下肺静脉10根,平均直径(15．87±6．12)mm。相应MSCT肺静脉成像所测得直径分别为(17．86±4．51)mm,(17．16±4．29)mm,(14．32±2．12)mm。共重建120例中国人肺静脉481根。3支者5例(4．2%),其中左共干者3例,右共干者2例；5支者6例(5%),其中左3支者3例,右3支者3例；4支者109例(90．8%)。房颤患者60例,MSCT肺静脉成像测得直径分别为左上肺静脉(17．02±4．13)mm,右上肺静脉(17．40±4．71)mm,左下肺静脉(14．23±3．83)mm,右下肺静脉(15．81±4．60)mm。非房颤患者60例,MSCT肺静脉成像所测得直径分别为左上肺静脉(17．97±3．32)mm,右上肺静脉(17．63±3．34)mm,左下肺静脉(15．30±2．26)mm,右下肺静脉(14．71±2．37) mm。普通消融导管组电隔离肺静脉80根,发生狭窄的10根(12．5%)；盐水灌注消融导管组电隔离肺静脉39根,发生狭窄4根(10．3%)。结论(1)中国人以4支肺静脉为主,极少部分人3支或5支；(2)盐水灌注消融导管隔离肺静脉狭窄发生率低于普通消融导管；(3)MSCT可作为无创性肺静脉消融术后随访检查手段。
Objective To assess the clinical value of multi-slice spiral computed tomograpgy （MSCT） in evaluation of pulmonary vein（PV） stenosis. Methods Sixty consecutive patients with paroxysmal atrial fibrillation（PAF） involved in this study. Electrophysiology study indicated that PAF originated from PVs. MSCT was performed in 30 patients before ablation. MSCT was performed in 13 of 30 patients in 3 months after ablation. MSCT was performed from 3 to 18 months after ablation in the other 30 patients. The selective angiography was performed in 70 PVs during ablation. Control group included 60 patients without history of AF. Results Diameter of PV was measured by PV angiography in 70 PVs, included 30 left superior PVs （LSPV）, 30 right superior PVs（RSPV） and 10 left inferior PVs（LIPV）. The mean diameter of LSPV,RSPV and LIPV were （ 18. 39 ±5.02）mm, （ 17.97 ±4. 89）mm and （ 15.87 ±6. 12） mm,respectively. Four hundred and eighty-one PVs were visualized by MSCT in 120 patients. Five ostial were presented in 6 patients, 3 ostial were presented in 5 patients, and 4 separated ostial were presented in 109 patients. In patients with AF, the mean diameter of LSPV, RSPV, LIPV, RIPV were （ 17.02 ± 4. 13 ） mm, （ 17.40 ± 4. 71 ） mm, （ 14. 23 ± 3.83 ） mm, （15.81 ±4. 60）mm,respectively. In patients without AF, the mean diameter of LSPV, RSPV, LIPV, RIPV were （17.97±3.32）mm, （17.63 ±3.34）mm, （15.30±2.26）mm, （14.71±2.31）mm,respectively. PV isolation with conventional catheter, 10 of 80 PVs developed in PV stenosis. PV isolation with irrigated-tip catheter, 4 of 39 PVs developed in PV stenosis. Conclusions （ 1 ） Most people have four PVs, a few people have three or five PVs;（2） Incidence of pulmonary vein stenosis is lower in pulmonary vein isolation by irrigated-tip catheter than by conventional catheter; （3） MSCT is an effective and safe tool in evaluating pulmonary vein.
出处
《中华心律失常学杂志》
2006年第3期198-202,共5页
Chinese Journal of Cardiac Arrhythmias
基金
国家自然科学基金(30270552)
关键词
多层螺旋CT
射频导管消融
心房颤动
Multi-slice spiral computed tomograpgy
Radiofrequency catheter ablation
Atrial fibrillation
