心尖部心脏静脉分布特征的初步探讨  

Characteristics of the coronary veins in the cardiac apex region

作　　者：陈国平[1] 李莹[2] 华奇峰[1] Chen Guoping Li Ying Hua Qifeng(Department of Radiology, N ingbo NO. 2 Hospital ,Ningbo 315010, China)

机构地区：[1]宁波市第二医院放射科,315010 [2]上海同济大学附属东方医院心内科

出　　处：《中华心律失常学杂志》2017年第4期315-319,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的 探讨心尖部心脏静脉属支的分布特征,为心脏再同步治疗（CRT）手术植入左心室导线提供指导依据.方法 2016年1月1日至2016年5月1日在宁波市第二医院行冠状动脉CTA成像的患者174例,观察心尖部心脏静脉属支的分布,记录其数目及其近端来源,测量其近端（心脏心尖部-中部交界处）管径.结果 心尖部心脏静脉属支来源：前间隔静脉162例、侧前静脉27例、侧静脉69例、侧后静脉101例、左心室后静脉38例、后间隔静脉170例,各属支出现率差异有统计学意义（P〈0.001）,主要来源有：后间隔静脉、前间隔静脉、侧后静脉;各属支近端（心脏心尖部-中部交界处）管径差异有统计学意义（P〈0.001）,管径较大者有：后间隔静脉、前间隔静脉、侧后静脉;管径≥2 mm的属支主要有：后间隔静脉,各属支间未见交通支静脉.结论 ①CRT手术左心室导线植入的靶静脉优先选择侧后静脉;②如果后间隔静脉作为靶静脉则建议应用远端有可伸展装置的导线,以避免导线固定于静脉远端.Objective To investigate the characteristics of the coronary veins in the cardiac apex region to provide important information for implanting the left ventricular electrode during cardiac resynchronization therapy（CRT）.Methods According to the exclusion criteria,174 cases with coronary CT angiography imaging data were enrolled in the present study.The distribution of the coronary veins in the cardiac apex region was assessed.The number of the veins and their origins were documented.And the diameter of the proximal segment of these ones was also measured.Results The veins in the cardiac apex region were originated from the anteroseptal veins in 162 cases,the anterolateral ones in 27 cases,the lateral ones in 69 cases,the posterolateral ones in 101 cases,the left ventricular posterior ones in 38 cases,and the posteroseptal ones in 170 cases.There was significant difference among the presence of the branches in the cardiac apex region（P〈0.001）.The major origins were the posteroseptal veins,the anteroseptal veins,and the posterolateral veins.There was statistically difference among the diameter of the proximal segments（P〈0.001）.Of all the origins,the posteroseptal veins,the anteroseptal veins,and the posterolateral veins were larger in terms of the diameter of the proximal segments.Moreover,most of the diameter of the posteroseptal veins were over 2 mm.Finally,there was no communicating veins among all the branches.Conclusions ①The posterolateral vein was the target vein of first choice for implanting the left ventricular electrode during CRT.②If the posteroseptal vein was selected as a target vein,the left ventricle electrode with extensible device was suggested to avoid being fixed in the distal segment of the vein.

关 键 词：心脏再同步治疗 心尖部 多排螺旋CT 

分 类 号：R541.6[医药卫生—心血管疾病] R816.2[医药卫生—内科学]