右心耳在导管介入治疗中的放射解剖学应用研究

Radiologic Anatomy of Right Atrial Appendage in Catheterization Intervention

目的研究右心耳在介入治疗中的应用解剖学参数和形态学分类。材料与方法112例拟行介入术的患者行64排CT心脏造影,应用软件Advantage Workstation 4.3从水平面分别以实体成像重建左、右心房,右心耳、主动脉,在二维和三维结构测量和分析右心耳相关参数并进行形态学分类。结果右心耳容积为18.2±6.8ml,右心耳与失状轴的夹角为25.5°±10.6°,绝大多数指向心脏左前方,右心耳高度为27.4±5.7mm,右心耳距上腔静脉的最大展距为40.6±8.1mm;右心耳分为反L型(42.7%)、水平型(36.6%)、L型(17.1%)、M型(3.7%)4种类型。结论右前斜60°透视时全部右心耳投影在上腔静脉轴线的左侧,而左前斜60°则全部投影在上腔静脉轴线的右侧,右心耳展距、高度和分型对于电极的置放具有指导作用。

Purpose To study the radiologic anatomy and morphological classification of right atrial appendage （RAA） for catheterization intervention. Materials and Methods In 112 patients with atrial fibrillation undergoing radiofrequency ablation, 64-Channel cardiac computed tomography was performed before procedure and Advantage Workstation 4.3 was used for image analysis. Three-dimensional geometry of RAA was reconstructed with volume rendered method on axial plane, Measurements and morphological classification were made on two-dimensional or three-dimensional images. Linear correlation analysis was performed. Results MeanRAA volume was （18.2±6.8） ml. The angle between thelong axis of RAAand the sagittal axis was （25.5±10.6）°. Most of the RAAs pointed to the left anterior direction of the heart. RAA height was （27.4±5.7）mm. The distance from the furthest point of RAA to superior vena cava was （40.6±8.1）ram. The shape of RAA were classified into 4 types： inversed L-shaped （42.7%）, horizontal （36.6%）, L-shaped （17.0%） and M-shaped （3.7%）. Conclusion All RAAsare projected to the left side of superior vena cava in right anterior oblique view of 60~ and to the right side in left anterior oblique view of 60°.Radiologic anatomic parameters and classification of right atrial appendage are useful for the guidance of catheterization.