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.

双源CT对大动脉转位冠状动脉评估的应用价值(/HTML )




Assessment of coronary artery anatomy in patients with transposition of the great arteries using dualsource computed tomography
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

transposition of the great arteries coronary artery tomography X-ray computed echocardiography

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。


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.


[1]FILES M D, ARYA B.Preoperative physiology, imaging, and management of transposition of the great arteries [J].Semin Cardiothorac Vasc Anesth, 2015, 19(3): 210-222. DOI: 10.1177/1089253215581851.
[2] YACOUB M, HOSNY H, AFIFI A. Surgery for TGA in developing countries: the end of the beginning [J]. J Am Coll Cardiol, 2017, 69(1): 52-55. DOI: 10. 1016 /j.jacc.2016. 10.050.
[3]SZYMCZYK K, MOLL M, SOBCZAKBUDLEWSKA K, et al. Usefulness of routine coronary CT angiography in patients with transposition of the great arteries after an arterial switch operation[J]. Pediatr Cardiol, 2018, 39(2): 335-346. DOI: 10.1007/s002460171761z.
[4] HUANG S C, CHIU I S, LEE M L, et al. Coronary artery anatomy in anatomically corrected malposition of the great arteries and their surgical implications[J]. Eur J Cardiothorac Surg, 2011, 39(5): 705-710. DOI: 10.1016/j.ejcts.2010.09.006.
[5]SCHIDLOW D N, JENKINS K J, GAUVREAU K, et al. Transposition of the great arteries in the developing world: surgery and outcomes [J]. J Am Coll Cardiol, 2017, 69(1): 43-51. DOI: 10.1016/j.jacc.2016.10.051.
[6]SITHAMPARANATHAN S, PADLEY S P, RUBENS M B, et al. Great vessel and coronary artery anatomy in transposition and other coronary anomalies: a universal descriptive and alphanumerical sequential classification [J]. JACC Cardiovasc Imaging, 2013, 6(5): 624-630. DOI: 10.1016/j.jcmg.2012.10.027.
[7]LIMPEROPOULOS C, TWORETZKY W, MCELHINNEY D B, et al. Brain volume and metabolism in fetuses with congenital heart disease: evaluation with quantitative magnetic resonance imaging and spectroscopy[J]. Circulation, 2010, 121(1): 26-33. DOI: 10.1161/CIRCULATIONAHA. 109. 865568.
[8]LENOIR M, BOUHOUT I, GAUDIN R, et al. Outcomes of the anatomical repair in patients with congenitally corrected transposition of the great arteries: lessons learned in a highvolume centre[J]. Eur J Cardiothorac Surg, 2018. [Epub ahead of print]. DOI: 10.1093/ejcts/ezy116.
[9]PASQUALI S K, HASSELBLAD V, LI J S, et al. Coronary artery pattern and outcome of arterial switch operation for transposition of the great arteries: a metaanalysis[J]. Circulation, 2002, 106(20): 2575-2580.
[10]XIE L J, JIANG L, YANG Z G, et al. Assessment of transposition of the great arteries associated with multiple malformations using dualsource computed tomography [J]. PLoS ONE, 2017, 12(11): e0187578. DOI: 10.1371/journal.pone.0187578.
[11]LALEZARI S, BRUGGEMANS E F, BLOM N A, et al. Thirtyyear experience with the arterial switch operation [J]. Ann Thorac Surg, 2011, 92(3): 973-979. DOI: 10.1016 /j.athoracsur.2011.04.086.
[12]OU P, KHRAICHE D, CELERMAJER D S, et al. Mechanisms of coronary complications after the arterial switch for transposition of the great arteries[J]. J Thorac Cardiovasc Surg, 2013, 145(5): 1263-1269. DOI: 10.1016/j.jtcvs.2012.06.009.
[13]YU F F, LU B, GAO Y, et al. Congenital anomalies of coronary arteries in complex congenital heart disease: diagnosis and analysis with dual source CT [J]. J Cardiovasc Comput Tomogr, 2013, 7(6): 383-390. DOI: 10.1016/j.jcct.2013.11.004.
[14]GROVES D W, OLIVIERI L J, SHANBHAG S M, et al. Feasibility of low radiation dose retrospectivelygated cardiac CT for functional analysis in adult congenital heart disease[J]. Int J Cardiol, 2017, 228: 180-183. DOI: 10.1016/j.ijcard. 2016.11.108.
[15]IHLENBURG S, ROMPEL O, RUEFFER A, et al. Dual source computed tomography in patients with congenital heart disease[J]. Thorac Cardiovasc Surg, 2014, 62(3): 203-210. DOI: 10.1055/s00331349791.
[16]EINSTEIN A J, MOSER K W, THOMPSON R C, et al. Radiation dose to patients from cardiac diagnostic imaging [J]. Circulation, 2007, 116 (11): 1290-1305. DOI: 10.1161/CIRCULATIONAHA. 107. 688101.
[17]MARUKAWA Y, SATO S, TANAKA T, et al.Evaluating LowkV dualsource CT angiography by highpitch spiral acquisition and iterative reconstruction in pediatric congenital heart disease patients[J]. Acta Med Okayama, 2017, 71(5): 407-412. DOI: 10.18926/AMO/55438.


[3]邹利光,文利,孙清荣,等.e-Speed 电子束CT对冠状动脉粥样硬化心脏病的诊断价值[J].第三军医大学学报,2006,28(01):3.
[4]邹利光,孙清荣,戚跃勇,等.e-Speed 电子束CT冠状动脉造影心电触发扫描时相与图像质量的关系[J].第三军医大学学报,2006,28(01):6.
 HE Guo-xiang,JIANG Qing-an,LIU Jian-ping,et al.Efficacy of weak steady direct current electrical fields in chronic myocardial infarction rabbits[J].J Third Mil Med Univ,2008,30(20):402.
 ZHANG Xue-mei,WANG Jian,LI Chuan,et al.Myocardial bridge: diagnosis with dual-source CT and clinical significance[J].J Third Mil Med Univ,2008,30(20):1897.
 Zou Liguang,Dai Shuhua,Zhang Dong,et al.Diagnosis of abnormal coronary artery origin with multislice spiral CT and its clinical significance[J].J Third Mil Med Univ,2010,32(20):1216.

更新日期/Last Update: 2018-11-01