超声心动图在冠状动脉瘘诊治中的临床应用价值

发布时间：2018-05-08 21:29

本文选题：经胸超声心动图 + 冠状动脉瘘　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:探讨经胸超声心动图(transthoracic echocardiography,TTE)对冠状动脉瘘(coronary artery fistula,CAF)诊断的应用价值及了解术后心脏解剖形态及功能的变化。方法:回顾性分析我院2010年3月至2017年2月,在心血管病研究所经外科开胸手术或经皮穿刺CAF封堵术的37例CAF患者的临床资料,包括:(1)收集所有CAF患者术前和术后一周内复查的TTE各项测量指标:左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、右室舒张末期前后径(RVEDD)、左房前后径(LAAPD)、左房左右径(LATD)、右房左右径(RATD)、左室缩短率(LVFS)、左室射血分数(LVEF)、左、右冠状动脉起始部主干内径(RCAD/LCAD)、瘘入部位、瘘口内径及瘘口处血流速和压差、各瓣膜反流及术后残余瘘情况。(2)对比术前冠脉CT增强(CT angiography,CTA)和选择性冠状动脉造影(selective coronary arteriography,SCA)检查准确率。(3)记录手术病理及手术方式。结果:所有CAF病例均经手术证实,TTE、SCA、冠脉CTA的CAF诊断准确率分别为89.1%、95.7%和96.8%。单支冠状动脉瘘36例(97.2%),其中右冠状动脉瘘21例(58.3%),左冠状动脉瘘15例(41.6%);双侧冠状动脉瘘仅1例(2.7%)。病变冠状动脉瘘入右心系统共35例(94.5%),其中入右室16例(43.2%),入右房14例(37.8%),入肺动脉5例(13.5%);瘘入左心系统仅2例(5.4%)。21例行修补术(其中1例行经皮穿刺CAF封堵术未成功,后转修补术),8例行结扎术,4例行缝闭术,4例行经皮穿刺CAF封堵术。术后心脏形态学各测量指标、病变冠脉起始部主干内径均较术前降低,与术前比差异均有统计学意义(P0.05);19例CAF术后患者心脏形态恢复正常。术后LVFS、LVEF较术前略有降低但差异无统计学意义(P0.05)。术后6例有残余分流。结论:TTE可应作为CAF诊断的首选方法,是手术疗效评价的有效检查方法。
[Abstract]:Objective: to investigate the value of transthoracic echocardiography (TTE) in the diagnosis of coronary artery fistula (artery) and to understand the changes of cardiac anatomy and function after operation. Methods: the clinical data of 37 patients with CAF who underwent thoracotomy or percutaneous CAF closure in our hospital from March 2010 to February 2017 were retrospectively analyzed. (including 1) collect all the TTE measurements before and within one week after CAF: left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDDD), right ventricular end-diastolic dimension (RVEDDD), left atrial anterior and posterior dimension (LAAPD), left atrium left and right diameter (LATD), right ventricular end-diastolic dimension (LVEDDD), left ventricular end diastolic diameter (LVEDDD), left and right atrial diameter (LATD). Left ventricular shortening rate (LVFSV), left ventricular ejection fraction (LVVEF), left ventricular ejection fraction (LVEF), left ventricular shortening rate (LVFSV), left ventricular ejection fraction (LVEF), The diameter of the main trunk of the right coronary artery at the beginning of the coronary artery was RCAD / LCAD, the location of the fistula, the internal diameter of the fistula, and the velocity and pressure difference of the blood flow at the fistula. The accuracy of coronary CT enhanced CT angiography and selective coronary angiography was compared with that of selective coronary angiography (SCA3) to record the operation pathology and the operation method of each valve regurgitation and postoperative residual fistula. Results: all cases of CAF were confirmed by operation. The diagnostic accuracy of CAF of coronary CTA was 89.1% and 96.880% respectively. There were 36 cases of single coronary artery fistula, including 21 cases of right coronary artery fistula, 15 cases of left coronary artery fistula, 1 case of bilateral coronary artery fistula, and 1 case of bilateral coronary artery fistula, among which 21 cases had right coronary artery fistula, 15 cases had left coronary artery fistula, and 1 case had bilateral coronary artery fistula. There were 35 cases of coronary artery fistula entering the right cardiac system, including 16 cases of right ventricle, 14 cases of right atrium, 5 cases of pulmonary artery, 5 cases of fistula into left cardiac system, and 2 cases of repair of fistula into left cardiac system (including 1 case without successful percutaneous CAF closure, 1 case with percutaneous transcatheter closure of the left ventricular system), 14 cases with right atrium, 5 cases with pulmonary artery, and 2 cases with fistula into the left cardiac system. 8 cases were treated with ligation and 4 cases with suture closure and 4 cases with percutaneous CAF closure. The heart morphology and the diameter of the main coronary artery were decreased after operation, and the difference was statistically significant (P 0.05). The cardiac morphology of 19 patients after CAF was normal. LVFSU LVEF after operation was slightly lower than that before operation, but the difference was not statistically significant (P 0.05). Residual shunt was found in 6 cases after operation. Conclusion: TTE should be the first choice in the diagnosis of CAF, and it is an effective method to evaluate the curative effect of operation.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R543.3;R540.45

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