国人主动脉瓣狭窄主动脉根部解剖的研究

The anatomical study of the aortic root of Chinese patients with aortic stenosis

目的:随着经导管主动脉瓣置换术的发展,了解主动脉根部的解剖对于主动脉瓣瓣膜支架的选择和减少并发症是非常必要的。方法:34例主动脉瓣狭窄患者及39例正常对照行双源CT(Dual Source CT,DSCT)及经胸心脏超声(transthoracicechocardiography,TTE)检查,DSCT在斜冠状面及矢状面分别测量收缩末期及舒张末期主动脉根部各径线,瓣环直径和左室流出道直径。超声测量主动脉根部及左室流出道直径,并且和DSCT测量值对比。结果:主动脉瓣狭窄组左冠状动脉(left coronaryostia,LCO)高度、右冠状动脉(right coronary ostia,RCO)高度、冠状窦(sinus of Valsalva,SV)直径、左右冠状窦高度与对照组相比,差异无统计学意义;主动脉瓣狭窄组瓣环(aortic annulus,AA)直径、主动脉窦和升主动脉连接处(Sino-Tubular Junction,STJ)直径、升主动脉(ascending aorta,AO)直径、左室流出道(left ventricular outer tract,LVOT)直径、主动脉瓣和二尖瓣之间纤维结构(continuity fibrous,CF)距离,室间隔(interventricular septum,IVS)厚度明显比对照组大(P<0.05)。主动脉瓣狭窄组及对照组收缩末期AA、SV、STJ、AO直径、IVS厚度明显比舒张末期大(P<0.05),收缩末期LVOT直径明显比舒张末期小(P<0.05)。主动脉瓣狭窄组及对照组AA及LVOT直径冠状面测量值均大于矢状面测量值。主动脉根部直径(AA、SV、STJ、AO)TTE测量值与DSCT测量值相比,相关性好(相关系数分别为r=0.84,r=0.87,r=0.82,r=0.82),差异均有统计学意义(P<O.05)。结论:主动脉瓣狭窄患者主动脉根部扩张、左室流出道变长扩张、室间隔变厚及冠状动脉变异较大,由于TTE的诊断作用有限,因此经导管主动脉瓣置换患者术前进行DSCT检查对于瓣膜支架的选择及减少并发症有重要意义。

Objective：To obtain the detailed knowledge of aortic root anatomy for reducing complications and selecting device size in chinese patients with catheter aortic valve replacement. Methods：Distances from the aortic annulus （AA） to major landmarks were measured with Dual Source CT（DSCT） at end-systole（ES） and end-diastole（ED） in 34 patients with aortic stenosis （AS） and 39 controls without valve pathology. AA and left ventricular outer tract （LVOT） diameter were assessed in 2 directions by reconstructed coronal and sagittal views. Aortic root and LVOT diameters were also measured with transthoracic echocardiography （TFE）. Results： Measurements of left and right coronary ostia height,coronary sinuses height,and sinus of Valsalva （SV） diameter did not differ significantly between controls and AS patients. AS patients had significantly larger diameter of AA,Sino-Tubular Junction （STJ）, ascending aorta （AO） and LVOT,larger thickness of interventricular septum （IVS） and larger distance of aorto-mitral continuity fibrous （CF） versus controls （P 〈 0.01 ）. In all subjects, diameters of AA, SV and STJ, and thickness of IVS were significantly larger in ES than ED （P 〈 0.05）. LVOT diameters were significantly smaller in ES than ED （P 〈 0.05）. AA and LVOT diameters were larger under coronal view than under sagittal views in all subjects. DSCT and TTE methods were significantly correlated for measurement of AA （r = 0.84）,SV （r = 0.87）,STJ（r = 0.82） and AO（r = 0.82）（All P 〈 0.05）. Conclusion：Aortic root dilatation,LVOT dilatation and elongation,IVS thickness and variable coronary ostial locations present in AS patients. TTE assessment had some limitations. Therefore, DSCT is recommended to select candidates and assess device size to avoid complications.