通过多层螺旋CT对慢性心力衰竭患者冠状静脉解剖变异的观察研究Observation and study on the anatomic variation of coronary vein in patients with chronic heart failure by multi-slice spiral CT
陈轶,李继文,蒋萍,李振,苏晞
摘要(Abstract):
目的通过多层螺旋CT三维重建技术观察与分析心脏再同步化治疗相关血管的解剖特征及变异情况。方法入选162例拟行心脏再同步化治疗的慢性心力衰竭患者,术前行冠状动脉CT成像明确冠状动脉病变,同时行冠状静脉CT三维重建,评估成像质量,并观察与心脏再同步化治疗相关的冠状静脉侧支及冠状静脉窦口的解剖特征及变异情况。结果 162例入选患者均完成了冠状静脉CT三维重建。对心脏再同步化治疗相关血管的成像质量分析表明,冠状静脉窦口的成像质量最佳,其次分别为后侧静脉、侧静脉及前侧静脉,而且上述与心脏再同步化治疗相关的血管存在较大的解剖变异。其中存在3支血管的占19.8%,存在2支血管的占35.8%,只有1支血管的占40.7%,而上述血管缺如的占3.7%。结论慢性心力衰竭患者的冠状静脉系统,尤其与心脏再同步化治疗相关的静脉侧支血管存在较大的解剖变异,冠状静脉CT三维重建对术前评估及术中决策具有一定的临床价值。
关键词(KeyWords): 多层螺旋CT;心脏再同步化治疗;冠状静脉
基金项目(Foundation): 武汉市卫生局临床医学科研资助项目(WX12C40)
作者(Author): 陈轶,李继文,蒋萍,李振,苏晞
参考文献(References):
- [1]张澍,黄德嘉,华伟,等.心脏再同步治疗慢性心力衰竭的建议(2013年修订版).中华心律失常学杂志,2013,17(4):247-261.
- [2]Lumia D,LaganàD,CanìA,et al.MDCT evaluation of the cardiacvenous system.Radiol Med,2009,114(6):837-851.
- [3]Blendea D,Shah RV,Auricchio A,et al.Variability of coronary venous anatomy in patients undergoing cardiac resynchronization therapy:a high-speed rotational venography study.Heart Rhythm,2007,4(9):1155-1162.
- [4]金炜,孟伟栋,汪芳,等.心脏再同步治疗患者心脏静脉血流异常分析.中华心律失常学杂志,2009,13(1):34-38.
- [5]Muhlenbruch G,Koos R,Wildberger JE,et al.Imaging of the cardiac venous system:comparison of MDCT and conventional angiography.AJR Am J Roentgenol,2005,185(5):1252-1257.
- [6]Gorcsan J.Finding pieces of the puzzle of nonresponse to cardiac resynchronization therapy.Circulation,2011,123(1):10-12.
- [7]Khan FZ,Virdee MS,Gopalan D,et al.Characterization of the suitability of coronary venous anatomy for targeting left ventricular lead placement in patients undergoing cardiac resynchronization therapy.Europace,2009,11(11):1491-1495.
- [8]Van de Veire NR,Schuijf JD,De Sutter J,et al.Non-invasive visualization of the cardiac venous system in coronary artery disease patients using 64-slice computed tomography.J Am Coll Cardiol,2006,48(9):1832-1838.
- [9]Strik M,Rademakers LM,van Deursen CJ,et al.Endocardial left ventricular pacing improves cardiac resynchronization therapy in chronic asynchronous infarction and heart failure models.Circ Arrhythm Electrophysiol,2012,5(1):191-200.
- [10]Schouwenburg JJ,Klinkenberg TJ,Maass AH,et al.Videoassisted thoracic placement of epicardial leads.J Card Surg,2014,29(2):286-289.
- [11]曹丙峰,刘庆霞,周建华.右室高位室间隔和心尖部起搏对心功能的影响.中国心血管病研究,2017,15(1):56-59.
- [12]Arnold AD,Shun-Shin MJ,Keene D,et al.His resynchronization versus biventricular pacing in patients with heart failure and left bundle branch block.Am Coll Cardiol,2018,72(24):3112-3122.