先天性左心耳发育不良或是左心耳未发育—探寻其影像学诊断及其临床意义  

Congenital Hypoplasia or Absence of Left Atrial Appendage-Exploring Its Imaging Diagnosis and Clinical Significance

作　　者：李炜 庞茂华 周华 王伟 袁明远 方明 Li Wei;PANG Mao-hua;ZHOU Hua;WANG Wei;YUAN Ming-yuan;FANG Ming(Radiology Department of Zhoupu Hospital in Pudong New Area,Shanghai 200000,China;Department of Cardiology,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200000,China)

机构地区：[1]上海浦东新区周浦医院放射科,上海200000 [2]上海中医药大学附属龙华医院心病科,上海200000

出　　处：《中国CT和MRI杂志》2024年第7期74-76,共3页Chinese Journal of CT and MRI

基　　金：上海市浦东新区卫生健康委员会科技项目(PW2021A-80)。

摘　　要：目的探寻左心耳发育不良和左心耳未发育的影像学表现,并了解此类先天性畸形的临床意义。方法收集我院2018年10月至2021年12月期间影像学诊断左心耳缺如患者5例,均有心脏CT血管造影(CT angiography,CTA)、经食道超声心动图(transesophageal echocardiography,TEE)及肺部CT平扫检查,对他们的影像和临床资料进行回顾性分析。结果5例食管超声检查中,3例报告左心耳未见显示,2例报告左心耳极细小且自发显影;5例肺静脉CTA中,1例肺静脉期及延迟期均未见左心耳显影;2例肺静脉期未见左心耳显影,延迟期极少量对比剂充盈左心耳;2例肺静脉期左心耳线状对比剂充盈,延迟期左心耳显影范围略扩大。5例肺部CT平扫均可以在正常位置显示极小的左心耳解剖形态。所有患者冠状静脉窦结构正常,管径不同程度扩张。5例房颤患者CHA2DS2-VASc卒中评分为7分,7分,6分,7分,6分,均为高危卒中患者,4例患者有反复腔隙性脑梗塞,1例患者曾发生有大面积脑梗塞。结论本组影像学初步诊断左心耳缺如的5例患者,结合其胸部CT平扫,发现左侧房肺沟均存在类似极小指状结构且其内部梳状肌发达、残余管腔极为细小,因此,类似病例是否左心耳真正解剖意义上的缺如值得商榷,归结为左心耳发育不良似乎更为妥当。左心耳发育不良的房颤患者,临床血栓事件并未减少,其临床卒中风险可能仅与CHA2DS2-VASc评分相关。Objective To explore the imaging manifestations of hypoplastic left atrial appendage(LAA)and absence of LAA,and to understand the clinical significance of these congenital cardiac malformations.Methods Five patients with absent left atrial appendage diagnosed by imaging from October 2018 to December 2021 in our hospital were collected.All of them had undergone cardiac CT angiography(CTA),transesophageal echocardiography(TEE),and plain CT scan of the pulmonary.Their imaging and clinical data were retrospectively analyzed.Results Of the 5 cases of esophageal ultrasound,3 cases reported no left atrial appendage display,and 2 cases reported a very small left atrial appendage with spontaneous visualization.Of the 5 cases of pulmonary vein CTA,1 case showed no left atrial appendage visualization in both the pulmonary vein and delayed phases;2 cases showed no left atrial appendage visualization in the pulmonary vein phase,with minimal contrast agent filling of the left atrial appendage in the delayed phase;2 cases showed linear contrast agent filling of the left atrial appendage in the pulmonary vein phase,with slightly expanded left atrial appendage visualization in the delayed phase.All 5 cases of lung CT plain scan could show minimal left atrial appendage anatomy in the normal position.All patients had normal coronary sinus structures,with varying degrees of dilation of the vessel diameter.The CHA2DS2-VASc stroke scores of the 5 atrial fibrillation patients were 7,7,6,7,and 6,all of whom were high-risk stroke patients.4 patients had recurrent lacunar cerebral infarction,and 1 patient had a large area of cerebral infarction.Conclusion In this group of 5 patients with a preliminary diagnosis of absence of the left atrial appendage based on imaging,combined with chest CT scans,it was found that there were similar extremely small fingerlike structures in the left atrial pulmonary sulcus,with well-developed internal pectinate muscles and extremely small residual lumens.Therefore,it is questionable whether similar cases re

关 键 词：左心耳发育不良 左心耳缺如 血栓栓塞 多模态影像学 

分 类 号：R543.13[医药卫生—心血管疾病]