CT重建技术在心下型完全性肺静脉异位引流中的应用

Computerized tomography reconstruction techniques in repair of infracardiac total anomalous pulmonary venous connection

目的研究心下型完全性肺静脉异位引流中肺静脉共汇-垂直静脉和双侧心房的空间位置关系。方法利用二维CT重建技术对心下型完全性肺静脉异位引流患儿的心脏增强CT进行重建。将肺静脉共汇-垂直静脉在冠状面上的投影落在左心房区域、在矢状面上与左心房有良好的前后对位关系归为左心房型心下型完全性肺静脉异位引流;投影落在右心房区域、与右心房有良好前后对位关系归为右心房型;投影落在双侧心房中间、和双侧心房有良好前后对位关系归为中间型。结果共有19例CT重建资料,其中左房型4例(21.05%),右房型8例(42.11%),中间型7例(36.84%)。结论二维CT重建技术证实心下型TAPVC中肺静脉共汇和双侧心房的位置关系存在变异,以偏向右心房为主。这一发现可能对心下型TAPVC手术方案的设计有重要意义。

Objective To explore the spatial relationships between pulmonary venous confluence （VC）-vertical vein （VV） and bilateral atriums in infracardiac total anomalous pulmonary venous connection （TAPVC）. Methods The spatial relationships between VC-VV and bilateral atriums were analyzed with the utilization of two-dimensional computerized tomography （CT） reconstruction technique on enhanced cardiac CT images of infracardiac TAPVC children. If the projection of VC-VV was lying on left atrium on coronal axis and VC-VV was directly behind left atrium on sagittal axis, this type of infracardiac TAPVC was classified as left atrial type. If the projection was lying on right atrium and VC-VV was directly behind right atrium, this type was classified as right atrial type. When the projection was lying on the middle of bilateral atriums and VC-VV was directly behind bilateral atriums, it was classified as middle type. Results In the total of 19 enhanced cardiac CT materials, 4（21.05%） were left atrial type, 8（42. 11%） were right atrial type, and 7（36.84%） were middle type. Conclusion In infracardiac TAPVC, the spatial relationships between VC-VV and bilateral atriums are always variant, and mainly incline toward right atrium rather than left atrium. During the repair of infracardiae TAPVC, it should be taken into consideration anastomosing VC-VV to right atrium or bilateral atriums, which possibly reduces the occurrence of posterior pulmonary venous obstruction.