升主动脉及主动脉瓣置换术后右心房耳分流的CT诊断

Aorto-right atrial fistula after ascending aortic replacement or aortic valve replacement

目的 探讨主动脉瓣和（或）升主动脉置换手术后,主动脉根部-右心房耳分流术患者的CT影像特点.方法 回顾性分析行主动脉根窦部手术且同时行右心房耳人工造口分流术的87例患者,术后采用电子束CT（EBCT）或16、64层CT扫描机行非心电门控连续容积增强扫描,扫描范围自主动脉弓上水平至左、右髂动脉分叉处.86例患者于术后2～20d内行首次CT检查,1例术后15年行CT检查.结果 87例患者CT均明确诊断主动脉血管吻合口漏,异常血流经右心房耳口引流入右心房.少量分流25例,中量分流47例,大量分流15例（其中1例患者术后15年升主动脉周围大量对比剂外溢,右心房、室明显增大）.术后复查CT超过2次的患者37例,其中10例随访期内见少至中量分流漏口消失,8例少量分流较前减少,14例少至中量分流较前无明显变化,5例中量分流者3个月后复查分流较前增加.结论 右心房耳分流术患者CT为首选检查手段,可明确分流情况且定量分类,根据其影像特点可为临床提供治疗依据,亦是术后随访的主要方法.

Objective To evaluate the CT features of aorto-right atrial fistula after aortic valve replacement（AVR） or ascending aortic replacement.Methods Eighty-seven patients with aortic-right atrial fistula underwent CT after operation.The CT features were retrospectively analyzed.Fistula was measured according to maximum width of the shunt.Results Aorto-right atrial fistula was detected in 87 patients after aortic valve replacement or ascending aortic replacement by CT scan. Among them,25 patients were diagnosed as mild aorto-right atrial fistula,47 patients as moderate,and 15 patients as severe.Thirty-seven patients underwent follow-up CT.Among them,10 patients with mild to moderate aorto-right atrial fistula were considered to have complete regression,8 patients with mild aorto-right atrial fistula considered to have incomplete regression,14 patients with mild to moderate aorto-right atrial fistula considered to have stable condition,and 5 patients with moderate aorto-right atrial fistula considered to have progression at the 3-month follow-up.Conclusion CT is a useful tool for defining aorto-right atrial fistula after AVR or ascending aortic replacement and for evaluating it in follow-up.