房间隔缺损封堵术后患者行心脏CTA检查的临床因素与价值

Assessment of the Symptomatic Patient After Transcatheter Atrial Septal Defect Closure by Cardiac CT

目的探讨房间隔缺损封堵术后有症状患者行心脏CT随访的临床因素及价值。方法 2006年7月-2011年6月期间房间隔缺损封堵术后行CT检查的53名患者依年龄分为两组,组A,年龄≥40岁,组B<40岁,分析患者行心脏CT检查的临床资料,包括患者年龄、临床症状、CT检查目的,CT检查结果等,进一步归纳患者行心脏CT检查的适应证及临床价值。结果共53例患者(男21,女32,平均年龄48.52,范围19-72岁);房间隔缺损封堵术后患者行心脏CT随访的临床因素主要为胸闷、气短及心悸,患者均常规行心电图、经胸超声及X线平片复查,不能明确诊断,需进一步除外冠状动脉粥样硬化性心脏病(37/53)及肺动脉栓塞(9/53);少数病例旨在评估术后异常心前区不适(3/55)及射频消融前评估肺静脉及除外左房血栓等(4/53)。CT结果显示,全部患者均不同程度存在肺动脉扩张征象。此外,A组42例患者中,9例患者检出冠状动脉粥样硬化性心脏病;4例患者检查出并存其它先天性心血管畸形,其中冠状动脉起源异常2例,肺静脉异位引流、多发房间隔缺损各1例。B组11名患者中,3例评估术后心前区异常不适者,分别显示封堵器形态或位置异常。A、B两组虽阳性率无显著性差异(P=0.73),但检查目的及结果不同。结论房间隔缺损封堵术后的临床症状须慎重对待,心脏CT检查能为不同年龄段的患者提供针对性的解剖学信息,有效弥补常规复查手段的不足。

Objective we sought to evaluate clinic considerations and image findings of Cardiac CT in symptomatic patients after transcatheter atrial septal defect （ASDs） closure. Methods A total of 53 symptomic patients who underwent CTA with post-transcatheter ASD closure were grouped according to age： Group A consisted of 42 adult and advanced patients （ 40 years）, and Group B included 11 younger patients （〈40 years）. clinical and CTA data analysis included age, gender, symptoms, and CT findings. Results Among 53 patients （32 were female, mean age 48.52 years , ranged 19-72 years）, the common postoperative symptoms for patient presenting hospital with are chest tightness, dyspnea and palpitation, and CTA were considerated to rule out CAD in 37 cases; 9 patients present dyspnea and CTA were considerated to rule out PE; 4 cases underwent CTA to evaluate left atrial and pulmonary vein before RF atrial fibrition, the complications were under consideration in 3 patients with abnormal precordial distress after transcatheter ASD closure. As for CT fingdings, dilatation of the pulmonary artery in varying degrees were noted in all patients, addition- ally, in group A consisted of 42 patients, coronary artery disease proved by coronary angiography were detected in 9 patients by cardiac CT, in addi- tion, cardiac CT detected 2 cases with anomalous origin of coronary artery, 1 partial abnormalous pulmonary vein connection （PAPVC）, and 1 case with a residual ASD. In group B with 11 patients,3 cases were noted with abnormal ASO position and shape respectively. Though the significant, the purpose and findings of CTA are both different. Though Positive CT findings did not significantly differ between two groups（P=0.73）, the essential abnormalities are absolutely differ. Conclusion Cardiac symptoms after ASO implant deserve thorough investigation, and cardiac CT is feasible in providing individual anatomic information in symptomatic patients at different ages, especially in patients with clinical questions left unanswered by routine examination.