基于双源CT增强扫描的动脉导管未闭的介入治疗

Transcatheter closure of patent ductus arteriosus based on the technique of dual-source CT angiography

目的评价术前双源心脏CT(DSCT)检查在动脉导管未闭(PDA)介入治疗中的临床应用价值,探讨脱离术中造影进行PDA介入治疗的方法。方法 38例经超声诊断为PDA的患者,其中21例术前行心脏DSCT检查,重建获得PDA影像,并与术中造影所显示PDA形态对比;在此基础上,后17例经超声诊断为PDA的患者,尝试根据术前CT检查结果指导选择合适的封堵器,术中不穿刺股动脉、不进行降主动脉造影,经静脉途径直接完成介入治疗,术中、术后以心脏超声随诊评价疗效。结果术中造影组21例PDA患者CT重建图像与术中造影影像形态高度一致,CT重建图像、术中造影PDA最窄径分别为(5.2±1.9)mm vs(4.7±1.7)mm(相关系数0.88);释放后封堵器腰部直径为(7.0±2.0)mm(与CT重建PDA最窄径相关系数为0.92,与术中造影PDA最窄径相关系数为0.90);术前接受CT检查、术中未进行造影,尝试直接封堵的17例患者皆成功完成介入治疗,CT重建PDA最窄径以及释放后封堵器腰部直径分别为(5.0±1.9)mm vs(6.7±2.2)mm,术后随访未见左肺动脉、降主动脉医源性狭窄。结论术前心脏DSCT检查可以获得准确的PDA解剖影像资料,初步临床资料显示,它可以替代术中造影,为PDA的介入治疗提供充足的支持;同时术前CT检查有助于发现合并的心脏大血管畸形,对于指导临床实践具有重要意义,但DSCT检查的辐射剂量问题以及如何减少辐射计量仍是一个需要考虑的问题。

Objective To evaluate the clinical applicability of the dual-souce CT angiography （DSCTA） technique in the procedure of patent duetus arteriosus（PDA） transcathter closure, and to intend to set up the protocol for PDA interventional therapy without catheter angiography. Methods 38 patients were diagnosed with PDA by transthoracic echocardio-graphy （TTE）. DSCT angiography were carried out in 21 cases among these patients. MPR and three-dimension rebuilding image were obtained to analyze imaging features, and DSCTA images were compared with the catheter angiogram during interventional procedure. Based on these elementary studies, the following 17 cases od PDA were transcatheter clo- sured guided by DSCTA, without femoral artery puncture, without catheter angiography in the descending aorta. TTE was used during the procedure and in the follow-up studies. Results Compared the DSCTA rebuilding images with the catheter angiogram, the relationships were very high [（5.2±1.9） mm vs （4.7±1.7） ram, r =0.88）]. After completely release, the waist diameter of the occluder was （7.0 ±2.0）mm, they had high relationships with the DSCTA and catheter angiogram measurements （ r =0.92 and 0.90 respectively）. The following 17 cases were examined by DSCTA and the narrowest diameter of PDA was （5.0± 1.9） ram, and the PDA occluders were determined by DSCTA images. Transcatheter closure was successfully achieved in all those 17 cases. The waist diameter of the oecluders after completely release was （6.7±2.2） mm. There was no evidence of mislocation and left pulmonary artery or descending aorta stenosis. Con- clusion Precise anatomic images of PDA can be obtained by DSCTA. Initial clinical practices showed that instead of catheter angiography, transcathetr closure of PDA can be guided by DSCTA. Additionally, DSCTA was also helpful to detect the combined abnormalities for the patients with PDA. But how to control the radiation dosage of DSCT should be taken into consideration.