磁共振成像在异位心脏移植中的应用价值  

Applied value of magnetic resonance imaging in heterotopic heart transplantation

作　　者：赵世华[1] 冯敢生[1] 蒋世良[2] 陆敏杰[2] 张岩[2] 闫朝武[2] 祁晓鸥[2] 韦云青[2] 曹程[2] 

机构地区：[1]华中科技大学同济医学院附属协和医院放射科,武汉430074 [2]中国医学科学院中国协和医科大学阜外心血管病医院放射科

出　　处：《中华老年心脑血管病杂志》2008年第5期337-340,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金(30670609);国家教委博士点专项科研基金(20050023042)

摘　　要：目的应用MRI观察冠状动脉旁路移植术联合室壁瘤切除术+异位心脏移植术后心脏结构、功能等变化。方法对5例行自体心脏冠状动脉旁路移植术联合室壁瘤切除术+异位心脏移植术患者,采用1.5T超导MRI扫描仪对心脏形态、功能、心肌灌注、延迟增强等进行综合评价。3例术前行MRI检查,5例术后1～17个月先后3次行心脏MRI扫描。结果5例患者术后临床症状均明显改善。3例手术后自体心脏左心室腔均较术前缩小,仅1例心功能明显提高,LVEF从18.4%提高到47.2%。移植术后5例患者中2例自体心脏左心室功能明显改善,LVEF分别上升至47.2%和52.1%,其供体心脏左心室收缩功能低下,LVEF分别为18.4%和22%;3例自体心脏功能恢复不佳的患者,供体心脏左心室收缩功能良好。所有供体心脏心肌首过灌注与延迟增强均无异常信号;所有自体心脏心肌首过灌注与延迟增强均无显著变化。结论MRI一站式无创性检查方法是异位心脏移植术较理想的评估方法。Objective To observe the morphological and functional outcome by magnetic resonance imaging after the heterotopic heart transplantation. Method From Apr. 2006 to Oct. 2007,5 patients with chronic myocardial infarction and severe cardiac dysfunction underwent coronary artery bypass graft plus removal of ventricular aneurysm and heterotopic heart transplantation. 1. 5 Tesla MRI scanner was used to evaluate the sizes of cardiac chambers, regional or global ventricular function,myocardial perfusion and late enhancement. All the 5 patients received MRI examination 3 times 1 month to 17 months after the operation,and 3 of them underwent MRI examination before the operation. Results All the 5 patients presented significant clinical improvement. Postoperative cavities of the left ventricles （LV） in situ decreased progressively in 3 cases who had received pre-operative MRI scanning. However, only one case showed significant functional improvement and LVEF increased from 18.4% to 47. 2%. In the post-operative follow up, the LV function of the hearts in situ showed significant improvement, and LVEF finally increased to 47.2% and 52.1%, respectively in 2 cases. No obvious improvement was found in the other 3 cases,but their heterotopic heart showed enough LVEF. No significant findings were observed either in the first pass perfusion or late enhancement in the postoperative examination. Conclusion ＂one-stop shop＂ MRI scanning is a suitable image modality for evaluating the curative effect of the heterotopic heart transplantation.

关 键 词：心脏移植 磁共振成像 心肌梗塞 心脏室壁瘤 

分 类 号：R654.2[医药卫生—外科学]