经食管三维超声心动图定量分析冠状动脉开口的解剖结构

Quantitative analysis of coronary artery ostia anatomy using three-dimensional trans-esophageal echocardiography

目的建立经食管三维超声心动图定量分析方法,分析冠状动脉开口的解剖形态。方法经食管三维超声心动图获取95例成年患者主动脉根部及冠状动脉开口等解剖结构的三维容积超声声像图。应用Philips QLab 3DQ测量技术,建立坐标系,确定3个相互垂直的平面:(1)以经过3个冠状动脉窦底的平面为横断面;(2)以垂直于主动脉窦管联合线平面为矢状面;(3)与横断面、矢状面相互垂直的平面为冠状面。测量参数包括:(1)左右冠状动脉开口长、宽、面积、开口平面高度;(2)冠状动脉流出道与主动脉根部在矢状面的夹角;(3)冠状动脉开口平面与主动脉根部、冠状动脉窦的空间分布位置。结果左冠状动脉开口多呈圆形或椭圆形,形态较规则,而右冠状动脉开口形态多样化,呈泪滴状、椭圆状等。右冠状动脉开口钙化(81/95,85.26%)较左冠状动脉开口钙化(56/95,58.95%)常见。左右冠状动脉开口的宽、面积及开口平面高度间差异均有统计学意义(t=3.85、3.86、-4.49,P均<0.01)。左冠状动脉开口多位于窦内(76/95,80.00%),以窦内的中上1/3为主(69/95,72.63%);右冠状动脉开口多位于窦外(53/95,55.79%)。右冠状动脉开口高于左冠状动脉,差异有统计学意义(χ2=25.91,P<0.01)。结论采用经食管三维超声心动图容积图像能够建立三维定量评价模型,可定量评价主动脉根部及冠状动脉开口等解剖结构。

Objective To quantitatively analyze the coronary artery ostia by three-dimensional trans-esophageal echocardiography(3D-TEE).Methods The full-volume images of aortic root and coronary artery ostia were acquired by 3D-TEE in 95 adult patients.The Philips QLab 3DQ measurement technology was employed to determine three mutually perpendicular planes:(1) The transverse plane cross the bottom of three coronary artery sinus.(2) The sagittal plane perpendicular to sino-tubular junction.(3) The coronal plane perpendicular to the aforementioned two planes.The following relevant parameters were measured and recorded:(1) Length,width,height and area of bilateral coronary artery ostia.(2) The angle between coronary arterial outflow tract and aortic root in sagittal plane.(3) The spatial distribution of coronary artery ostia,aortic root and coronary artert sinus.Results The shape of left coronary artery ostia were more regular(round or oval) than right coronary artery ostia(teardrop-shape or oval).Calcification was more frequent in right coronary artery ostia(81/95,85.26%) than that in left coronary artery ostia.There were statistical differences between left and right coronary artery in the parameters of ostial wide,area and height(t =3.85,3.86,-4.49,all P<0.01).Most left coronary artery ostia were located inside the sinus(76/95,80.00%),mainly in the upper third segment(69/95,72.63%);while more than half of the right coronary artery ostia were found outside the sinus(53/95,55.79%).The difference was statistically significant(χ2=25.91,P<0.01).Conclusion The quantitative analysis of aortic root and coronary artery ostia based on the full-volume images originated from real-time 3D-TEE is feasible,which is helpful for further clinical research.