计算机断层摄影术在经皮肺动脉瓣植入术的应用及评价

发布时间：2018-05-14 16:41

本文选题：肺动脉瓣闭锁不全 + 体层摄影术　；参考：《中国循环杂志》2017年05期

【摘要】：目的:计算机断层摄影术(CT)评估肺动脉根部结构在经皮肺动脉瓣植入术(PPVI)的应用。方法:对2014-05至2016-07在我院拟行PPVI的19例肺动脉瓣重度关闭不全患者进行研究。分别行CT、经胸超声心动图检查(TTE)采集肺动脉根部解剖数据,并对比肺动脉瓣环测量差异。通过术后1~26个月随访,评估术前测量准确性。结果:l9例患者术前CT测量肺动脉瓣环平均内径(24.3±3.5)mm,肺动脉瓣窦管结合部内径(25.4±4.0)mm,主肺动脉远端平均内径(27.5±4.8)mm,右心室流出道平均内径(36.8±7.3)mm、主肺动脉长度(45.5±7.0)mm,左肺动脉开口内径(17.9±1.5)mm,右肺动脉开口内径(18.5±3.6)mm;TTE测量肺动脉瓣环内径(22.4±4.4)mm。CT测量肺动脉瓣环平均内径均值大于TTE测量肺动脉瓣环内径均值,差异有统计学意义(P0.05)。随访1~26个月,19例患者均未出现支架断裂或移位、瓣周漏、肺动脉瓣少量以上反流或冠状动脉狭窄,1例右肺动脉开口受支架的裙部阻挡流速增快,2例肺动脉瓣残余轻度狭窄。结论:CT及TTE对于肺动脉瓣环测量结果存在差异,CT可准确有效评估肺动脉根部形态及毗邻,在PPVI术前评估中有重要的应用价值。
[Abstract]:Objective: to evaluate the pulmonary artery root structure in percutaneous pulmonary valve implantation (PPVI) by computed tomography (CT). Methods: 19 patients with severe pulmonary valve insufficiency undergoing PPVI from 2014-05 to 2016-07 in our hospital were studied. The anatomical data of pulmonary artery root were collected by CT and transthoracic echocardiography (TTE), and the difference of pulmonary annulus was compared. The accuracy of preoperative measurement was evaluated by 1 ~ 26 months follow-up. Results the mean diameter of pulmonary annulus was 24.3 卤3.5 mm, the diameter of pulmonary sinus junction was 25.4 卤4.0 mm, the average diameter of distal main pulmonary artery was 27.5 卤4.8 mm, the mean diameter of right ventricular outflow tract was 36.8 卤7.3 mm, the length of main pulmonary artery was 45.5 卤7.0 mm, the diameter of left pulmonary artery was 45.5 卤7.0 mm, the average diameter of right ventricular outflow tract was 36.8 卤7.3 mm, the diameter of pulmonary artery was 25.4 卤4.0 mm, the average diameter of distal end of main pulmonary artery was 27.5 卤4.8 mm. The diameter of right pulmonary artery orifice was 18.5 卤3.6mm and the mean value of pulmonary annulus was 22.4 卤4.4)mm.CT. The mean value of pulmonary annular diameter measured by TTE was larger than that of TTE. The difference was statistically significant (P 0.05). 19 patients were followed up for 1 to 26 months without stent rupture or displacement, perivalvular leakage, pulmonary valve regurgitation or coronary artery stenosis in 1 case, right pulmonary artery orifice increased by the skirt blocking flow velocity in 2 cases, residual pulmonary valve residual slight stenosis in 2 cases. Conclusion there are differences in the measurement results of pulmonary annulus between CT and TTE. Ct can accurately and effectively evaluate the shape and proximity of pulmonary artery root. It has an important application value in preoperative evaluation of PPVI.
【作者单位】：中国医学科学院北京协和医学院国家心血管病中心阜外医院放射科;中国医学科学院北京协和医学院国家心血管病中心阜外医院心外科;中国医学科学院北京协和医学院国家心血管病中心阜外医院超声科;
【分类号】：R654.2

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