[1]曾涵江,徐忠孜,张丽芝,等.双源CT对大动脉转位冠状动脉评估的应用价值[J].第三军医大学学报,2018,40(20):1876-1882.
 ZENG Hanjiang,XU Zhongzi,ZHANG Lizhi,et al.Assessment of coronary artery anatomy in patients with transposition of the great arteries using dualsource computed tomography[J].J Third Mil Med Univ,2018,40(20):1876-1882.
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双源CT对大动脉转位冠状动脉评估的应用价值(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
40卷
期数:
2018年第20期
页码:
1876-1882
栏目:
临床医学
出版日期:
2018-10-30

文章信息/Info

Title:
Assessment of coronary artery anatomy in patients with transposition of the great arteries using dualsource computed tomography
作者:
曾涵江徐忠孜张丽芝粟丽余建群
四川大学华西医院放射科;四川省肿瘤医院放射科
Author(s):
ZENG Hanjiang XU Zhongzi ZHANG Lizhi SU Li YU Jianqun

Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041; Department of Radiology, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan Province, 610041, China

关键词:
大动脉转位冠状动脉体层摄影术X线计算机超声心动图
Keywords:
transposition of the great arteries coronary artery tomography X-ray computed echocardiography
分类号:
R541.1;R814.42
文献标志码:
A
摘要:

目的    探讨双源CT(dual-source computed tomography,DSCT)对大动脉转位(transposition of the great arteries,TGA)患者术前冠状动脉解剖及相关畸形的诊断价值和优势。方法    回顾性分析四川大学华西医院2010年1月至2017年10月同时行双源CT和超声心动图检查的大动脉转位患者43例(TGA组),根据TGA组年龄分布纳入该院经DSCT诊断为心脏形态和结构正常者43例作为对照组。分析大动脉转位类型、主动脉与肺动脉的空间关系、冠状动脉及相关畸形,并与手术结果对照,比较DSCT和超声心动图(transthoracic echocardiogram,TTE)诊断冠状动脉解剖结构的准确率。分析比较TGA组和对照组冠状动脉走行、冠状动脉开口与主动脉瓣距离和冠脉角。结果    TGA组有34例(79%)主动脉位于肺动脉左前(AL)或右前(AR)。12例患者合并冠状动脉畸形(12/43,28%),其中11例冠状动脉开口异常,1例冠状动脉起始部狭窄。完全性TGA最常见的冠脉类型为prR;plACx,而矫正性TGA为arR;pACx。TGA组左冠脉角和左、右冠脉至主动脉瓣距离均较对照组大(P<0.01),而右冠脉角较对照组小(P<0.01)。DSCT和TTE的大血管异常诊断准确率分别为100%(43/43)、76.7%(33/43),冠状动脉解剖结构诊断准确率分别为97.7%(42/43)、62.8%(27/43),显示DSCT在心外畸形方面明显优于TTE。结论    DSCT能客观、准确显示大动脉转位患者的冠状动脉解剖特征,对术前冠状动脉评估具有重要价值。

Abstract:

ObjectiveTo assess the value of dual-source computed tomography (DSCT) in preoperative diagnosis of anatomical abnormalities of the coronary artery in patients with transposition of the great arteries (TGA). MethodsThe clinical and image data were retrospectively analyzed for 43 patients with TGA, who underwent DSCT and transthoracic echocardiography (TTE) examination between January, 2010 and October, 2017 in West China Hospital. Another forty-three age-matched individuals with normal cardiac structures as confirmed by DSCT were enrolled to serve as the control group. The morphological types of TGA, the spatial relationship between the aorta and the pulmonary artery, coronary artery-associated abnormalities and accompanying defects were retrospectively assessed based on the findings by DSCT and TTE, and the diagnostic accuracy of these two modalities were determined with surgical or digital subtraction angiography (DSA) findings as the reference. The type of the coronary arteries, the distance between the coronary ostia and the aortic valve, and the coronary angle were compared between the patients with TGA and the control individuals. ResultsAmong the 43 patients with TGA, 34 (79%) had great arteries with an oblique spatial relationship shown by DSCT; 12 (28%) patients were found to have coronary artery malformations, including 11 with an abnormal coronary origin and 1 patient with stenosis of the coronary ostium. The most common coronary type of complete TGA was prR;plACx, as compared with arR;pACx in congenitally corrected transposition. The left coronary angle and bilateral coronary-aortic valve distance were significantly greater (P<0.01), while the right coronary angle was significantly smaller in TGA patients than in the control group (P<0.01). According to DSA or surgical findings, DSCT had significantly higher sensitivities than TTE in diagnosing anomalies of the great vessels (100% vs 76.7%) and coronary artery-associated abnormalities (97.7% vs 62.8%). ConclusionDSCT allows objective and accurate anatomical assessment of the coronary artery in patients with TGA and thus offers a valuable imaging modality for preoperative assessment of the coronary artery to assist in surgical decisionmaking.

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更新日期/Last Update: 2018-11-01