基于心脏CT血管成像的三维重建在经皮左心耳外盖型心脏封堵器植入术中的临床应用  

Clinical application of three-dimension reconstruction from cardiac CT angiography in percutaneous left atrial appendage occlusion with amplatzer cardiac plug

作　　者：王子荣[1] 杨栋[2] 张邢炜[2] 陈晓飞 WANG Zirong;YANG Dong;ZHANG Xingwei;CHEN Xiaofei(Department of Medical Imaging,Affiliated Hospital of HangzhouNormal University,Hangzhou 310015,China)

机构地区：[1]杭州师范大学附属医院医学影像科,310015 [2]杭州师范大学附属医院医学心内科,310015

出　　处：《心电与循环》2020年第5期424-428,共5页Journal of Electrocardiology and Circulation

基　　金：浙江省医药卫生科技计划项目(2020KY712);杭州市科技发展计划项目(20170533B45);杭州市卫生科技计划重大项目(2017ZD02)。

摘　　要：目的评估心脏CT血管成像(CCTA)三维重建在外盖型心脏封堵器(amplatzer cardiac plug,ACP)经皮左心耳封堵术中的临床应用价值。方法选择2017年3月至2018年11月杭州师范大学附属医院非瓣膜性心房颤动患者30例(男18例,女12例,年龄47~83岁),术前行心电门控心脏CT血管造影检查和经食管超声心动图检查(TEE),采用二维CT图像(CT-2D),重建三维CT图像(CT-3D),测量左心耳着落区最长径、最短径及深度,比较CT-2D与CT-3D着落区最长径及封堵器大小之间的相关性。术后3、12个月复查TEE和(或)CCTA,观察封堵器的位置、有无残腔及渗漏。结果30例患者均手术成功。CT-2D测得左心耳着落区最长径、最短径及深度分别为(21.7±3.7)mm、(17.0±3.5)mm和(18.2±3.5)mm。CT-3D测得左心耳着落区最长内径和最短内径为(23.4±3.4)mm和(18.0±3.9)mm,最长外径、最短外径及深度分别为(24.8±3.1)mm、(19.6±4.1)mm和(19.8±4.0)mm。封堵器尺寸为(25.9±3.0)mm。CT-3D测得的最长外径与ACP大小相关性最好(r=0.866,P<0.05)。术后仅见1例极少量(≤2.8 mm)左心耳封堵器边缘残余分流。结论CT-3D上着落区最长外径适合用于外盖型心脏封堵器大小的选择。Objective To investigate the clinical application of three-dimension reconstruction from cardiac computed tomography(CT)angiography(CCTA)in percutaneous left atrial appendage(LAA)occlusion with amplatzer cardiac plug(ACP).Methods 30 patients(18 males,12 females,aged from 47 to 83 years)with non-valvular atrial fibrillation were enrolled.ECG-gated CCTA and transesophageal echocardiography(TEE)were performed before the procedure of LAA closure.Three-dimensional CT imaging(CT-3D)was reconstructed from CCTA.The maximum diameter,minimum diameter and depth at the landing zone were measured.The relationships between the size of APC and the maximum diameter measured on two-dimensional CT images(CT-2D)and CT-3D were analyzed.The TEE and/or CCTA were performed to observe the location of the occluder,residual cavity and leakage at 3 and 12 months after the operation.Results The procedure of LAA occlusion was successful in all 30 patients.The maximum diameter,minimum diameter and depth at landing zone were(21.7±3.7)mm,(17.0±3.5)mm and(18.2±3.5)mm,respectively,on CT-2D.The maximum and minimum internal diameters were(23.4±3.4)mm and(18.0±3.9)mm,respectively,the maximum external dimension,minimum external dimension and depth were(24.8±3.1)mm,(19.6±4.1)mm and(19.8±4.0)mm,respectively,on CT-3D.The size of ACP was(25.9±3.0)mm.There was strongest correlation between the maximum external dimension on CT-3D and the size of ACP(r=0.866,P<0.001).One case had a very small amount(≤2.8 mm)of residual shunt at the edge of LAA occluder after the procedure.Conclusion The maximum external diameter in the landing zone on CT-3D is suitable for LAA APC size selection.

关 键 词：心脏CT血管造影 三维重建 心房颤动 左心耳 

分 类 号：R654.2[医药卫生—外科学]