应用计算机断层扫描识别二尖瓣术中左回旋支动脉损伤的危险因素  

Application of computed tomography to identify risk factors for left circumflex artery injury during mi⁃tral surgery

作　　者：刘进平 沈斐敏 郑桂安 黄素华 林益民 黄明城 LIU Jin-ping;SHEN Fei-min;ZHENG Gui-an;HUANG Su-hua;LIN Yi-min;HUANG Ming-cheng(Department of Cardiothoracic Surgery,Zhangzhou Hospital Affiliated to Fujian Medical University,Zhang-zhou,Fujian 363000,China;Department of Cardiology,Zhangzhou Hospital Affiliated to Fujian Medical Uni-versity,Zhangzhou,Fujian 363000,China;Department of Radiotherapy,Zhangzhou Hospital Affiliated to Fujian Medical University,Zhangzhou,Fujian 363000,China)

机构地区：[1]福建医科大学附属漳州市医院胸心外科,福建漳州363000 [2]福建医科大学附属漳州市医院心内科,福建漳州363000 [3]福建医科大学附属漳州市医院放疗科,福建漳州363000

出　　处：《岭南心血管病杂志》2022年第5期431-437,共7页South China Journal of Cardiovascular Diseases

基　　金：福建省自然科学基金项目(项目编号:2020J011293)。

摘　　要：目的使用三维计算机断层扫描(computed tomography,CT)探讨左回旋支动脉(left circumflex coronary artery,LCX)和二尖瓣环之间的解剖关系,并识别二尖瓣术中LCX损伤的危险因素。方法回顾性分析2017年1月至2020年7月福建医科大学附属漳州市医院收治的122例二尖瓣反流患者术前心脏CT图像,判断冠状动脉优势类型及是否存在二尖瓣环分离,使用经食道超声心动图分析二尖瓣反流病因。检测二尖瓣环上最接近LCX的点(X点),测量LCX到二尖瓣环的最小距离(minimum distance between left circumflex artery and mitral annulus,mDistanceLCX-MA)。应用单因素和多元回归分析影响mDistanceLCX-MA的相关因素。结果中位mDis⁃tanceLCX-MA为4.2(0.9~11.4)mm,X点主要位于后瓣环的外侧。51例(42%)患者出现二尖瓣环分离。与其他优势类型相比,左优势型的mDistanceLCX-MA最短(P<0.01)。与心房功能性二尖瓣反流组相比,黏液样病变二尖瓣脱垂组患者的mDistanceLCX-MA明显缩短(P=0.04)。多元回归分析显示,左优势型和二尖瓣环分离是减少mDis⁃tanceLCX-MA的重要独立因素(P值均为0.01)。相反,右优势型是增加mDistanceLCX-MA的重要独立因素(P=0.01)。结论术前心脏三维CT检查有助于判断LCX和二尖瓣环之间的解剖关系。左优势型和二尖瓣环分离的患者在行二尖瓣手术时存在LCX损伤的高风险。Objectives To investigate the anatomical relationship between the left circumflex coronary artery(LCX)and the mitral annulus using three-dimensional computed tomography(CT),and identify risk factors for LCX injury during mitral surgery.Methods We retrospectively reviewed 122 patients with mitral regurgitation(MR)from January 2017 to July 2020 in Zhangzhou Hospital Affiliated to Fujian Medical University.The coronary dominance and mitral annular disjunction were assessed using cardiac CT images before surgery.MR etiologies were evaluated by transesopha⁃geal echocardiography.The point on the mitral annulus closest to the LCX(X point)was detected and the minimum distance from the LCX to the mitral annulus(mDistanceLCX-MA)was measured.Univariate and multiple regression analysis were performed to identify independent factors affecting mDistanceLCX-MA.Results The median mDistanceLCX-MA was 4.2(0.9-11.4)mm.The X point mostly existed on the lateral side of the posterior annulus.Mitral annular disjunction was observed in 51 cases(42%).Compared with other types of coronary dominance,the left dominance had a significantly shorter mDistanceLCX-M(P<0.01).mDistanceLCX-MA in patients with mitral valve prolapse with myxomatous degeneration was significantly shorter compared with patients with atrial functional MR(P=0.04).Multiple regression analysis revealed that left dominance and mitral annular disjunction as significant independent factors which reduced mDistanceLCX-MA.Conversely,right dominance was a significant independent factor that increased mDistanceLCX-MA.Conclusions Threedimensional CT exam before surgery may help to identify the anatomical relationship between LCX and the mitral annulus.Patients with left coronary artery dominance and mitral annular disjunction may be at a high risk of LCX injury during mitral valve surgery.

关 键 词：二尖瓣 左回旋支动脉 冠状动脉损伤 计算机断层扫描 二尖瓣环分离 

分 类 号：R542.51[医药卫生—心血管疾病]