基于左心耳CT造影三维重建测量参数指导经皮左心耳封堵术的可行性  

Feasibility of guiding percutaneous left auricular occlusion based on 3D reconstruction measurement parameters of left atrial appendage CT angiography

作　　者：祁冬[1] 李辉[2] 施彪[1] 李科民[3] 符赵鑫 姚木子 Dong Qi;Hui Li;Biao Shi;Kemin Li;Zhaoxin Fu;Muzi Yao(Department of Medical Imaging,First People's Hospital of Bengbu City,Bengbu 233000 China;Department of Cardiovascular Medicine,The First Affiliated Hospital of Bengbu Medical College,Bengbu 233004 China;Department of Cardiovascular Medicine,First People's Hospital of BengbuCity,Bengbu 233000 China)

机构地区：[1]蚌埠市第一人民医院医学影像科,蚌埠233000 [2]蚌埠医学院第一附属医院心血管内科,蚌埠233004 [3]蚌埠市第一人民医院心血管内科,蚌埠233000

出　　处：《湖南师范大学学报（医学版）》2022年第6期92-96,共5页Journal of Hunan Normal University(Medical Sciences)

摘　　要：目的:探讨应用左心耳(LAA)CT造影三维重建测量参数在指导经皮左心耳封堵的可行性.方法:回顾性收集2018年1月至2022年3月在蚌埠市第一人民医院采用Watchman封堵器对30例非瓣膜性心房颤动患者行LAA封堵的相关资料.术前对所有患者均进行LAA CT造影检查,分别采用CT-2D、3D外侧法及3D内测法测量LAA最长径、最短径及深度.采用Pearson相关分析LAA各参数与最终置入Watchman封堵器尺寸大小的相关性,并将相关性最好的测量参数和封堵器尺寸大小做线性回归分析.在术后3个月复查经食管超声心动图(TEE)和(或)LAA CT造影,观察封堵器有无残余分流及位置移动.结果:30例患者中封堵成功29例(残余分流≤5mm),封堵不完全1例(残余分流>5mm).在封堵成功的29例患者中,最终置入封堵器尺寸大小为(30.30±2.49)mm,CT-2D测量LAA着陆区最长径、最短径以及深度与置入封堵器尺寸大小均呈正相关(r=0.686、0.575、0.513,均P<0.05);3D外侧法测量LAA着陆区最长径、最短径以及深度与置入封堵器尺寸大小均呈正相关(r=0.765、0.643、0.597,均P<0.05);3D内侧法测量LAA着陆区最长径、最短径以及深度置入封堵器尺寸大小均呈正相关(r=0.623、0.448、0.429,均P<0.05).对经LAA三维重建CT-2D、3D外侧法及3D内测法测量数据的29例患者进行封堵器尺寸预测,预测准确率分别为79.31%(23/29)、89.66%(26/29)及68.97%(20/29).结论:左心耳CT造影三维重建测量参数与封堵器尺寸大小均具有较好的相关性,尤以3D外侧法最长径相关性最好,在用于封堵器尺寸大小选择方面更具有指导意义,值得临床推广应用.Objective To explore the feasibility of applying left atrial appendage(LAA)CT angiography 3D reconstruction measurement parameters in guiding percutaneous left auricular occlusion.Method Data related to LAA occlusion using Watchman blocker in 30 patients with non-valvular atrial fibrillation from January 2018 to March 2022 were retrospectively collected at the First People's Hospital of Bengbu City.LAA CT angiography was performed in all patients,and the longest diameter,shortest diameter and depth of LAA were measured by CT-2D,3D external method and 3D internal measurement method,respectively.Pearson correlation was used to analyze the correlation between each parameter of the LAA and the size of the final placement of the Watchman blocker,and a linear regression analysis was done between the measured parameters with the best correlation and the size of the blocker.Transesophageal echocardiography(TEE)and/or LAA CT angiography were repeated at 3 months after the procedure to observe any residual shunt and position movement of the blocker.Results Of the 30 patients,29 were successfully blocked(residual shunt≤5 mm)and 1 was incompletely blocked(residual shunt>5 mm).Of the 29 patients with successful blockage,the final size of the inserted blocker is(30.30±2.49)mm;the longest diameter,shortest diameter,and depth of the LAA landing zone measured by CT-2D were positively correlated with the size of the inserted blocker(r=0.686、0.575、0.513,all P<0.05).The longest diameter,shortest diameter and depth of the LAA landing zone measured by the 3D outer method were positively correlated with the size of the placed blocker(r=0.765.0.643.0.597,all P<0.05);the 3D medial method of measuring the longest diameter and shortest diameter of the LAA landing zone,as well as the size of the depth-placed blocker,were positively correlated(r=0.623,0.448,0.429,all P<0.05).Prediction of blocker size in 29 patients with data measured by LAA 3D reconstruction CT-2D,3D external method and 3D internal measurement method,the prediction a

关 键 词：左心耳CT造影 心房颤动 封堵 Watchman封堵器 

分 类 号：R816.2[医药卫生—放射医学]