十字交叉心脏的CT诊断

CT diagnosis of criss-cross heart

目的探讨CT在十字交叉心脏（CCH）诊断中的临床价值。方法对经CT诊断并手术证实的5例CCH患者进行分析，其中2例行64层SCT增强扫描，3例行电子束CT单层增强扫描。以横断面扫描为基础，采用3D重组方式显示解剖畸形，并采用卡方检验与超声心动图和心血管造影比较。结果（1）所有患者呈心房内脏正位、交叉但适应性房室连接、水平室间隔、室间隔缺损与肺动脉狭窄。心室动脉连接异常，包括4例右室双出口，1例完全性大动脉错位。此外，2例永存左上腔静脉，主动脉缩窄及主动脉右弓右降各1例。（2）手术证实畸形共33处，CT、心血管造影与超声心动图诊断正确率分别为93．9％（31／33）、81．8％（27／33）和54．5％（18／33）。CT扫描及其3D重组较超声心动图有明显优势（X2=13．39，P〈0．01），与心血管造影差异无统计学意义（X2=1．29，P〉0．05）。结论CT是一种较为理想的诊断CCH的影像方法。

Objective To probe the clinical application of CT in the diagnosis of criss-cross heart （CCH）. Methods Five patients with CCH confirmed by operation were retrospectively analyzed. Enhanced 64-slice spiral CT was performed in 2 patients and enhanced single-slice electron beam CT was performed in 3 patients. Three dimensional reconstructions were applied for the fully display of anatomic malformations, and the results were compared with that of echocardiogram and angiocardiogram with Chi-square test. Results （1） Visceroatrial situs solitus, twisted and concordant atrioventricular connection, horizontally oriented ventricular septum, ventricular septum defect and pulmonary stenosis were found in all patients on CT. The ventriculoarterial connection was discordant, including double-outlet right ventricle in 4 patients and complete transposition of great arteries in 1 patient. In addition, associated anomalies including persistent left superior vena cava （ n = 2）, coarctation of the aorta （ n = 1 ） and right aortic arch with right descending aorta （n =1） were detected as well. （2） Total 33 anomalies in 5 cases were found during operation. The diagnostic accuracy of CT, angiocardiogram and echocardiogram was 93.9% （31/33）, 81.8% （27/33） and 54. 5% （18/33） respectively. There was a significant difference between CT and echoeardiogram （X2 = 13.39, P 〈 0. 01 ）, and no significant difference between CT and angioeardiogram （ X2 = 1.29, P 〉 0.05 ）. Conclusion CT is an excellent imaging technique for the diagnosis of CCH.