MSCT在先天性复杂畸形心脏病术后复查中的应用价值

The Clinic Value of MSCT for Congenital Heart Diseases Post-Operatively

目的探讨多排螺旋CT在先天性心脏病术后复查的应用价值。方法对我院2006年至2010年期间,21例复杂先天性心脏病患者术前、术后(间隔平均时间约1.5~3年)均有完整影像学资料的患者,将其CT、超声检查结果行回顾性分析,测量肺动脉Macoon比值和左室舒张末期容积,并将此结果运用统计学方法对比。以及体肺分流血管通畅与否,以期为临床提供二期手术时机判断的指标。结果 21例患者中,右室双出口3例,法洛氏四联症5例,肺动脉闭锁3例,单心室2例,三尖瓣闭锁2例,主动脉缩窄3例,完全性大动脉转位3例。前5种肺少血复杂畸形共15例患者,均因肺动脉发育差而行一期手术,如中央分流、改良B-T分流或双向Gleen术,术后患者肺动脉较术前有不同程度地发育,其中7例行介入封堵+先心矫治杂交手术,5例行Fontan类二期手术;将此15例患者行一期手术前、后CT所测肺动脉Macoon比值和左室舒张末期容积、以及体肺分流血管通畅与否与超声检查结果对比,并进行统计学分析,显示CT测量结果与超声相比有显著统计学意义。3例降主动脉缩窄患者,术后显示缩窄处及迂曲增粗的侧支血管较术前明显改善,3例大动脉转位术后复查显示矫治效果满意;一例肺动脉闭锁患者行双向Gleen术后7年,因不明原因咯血行CT检查发现肺动静脉瘘。结论经术后超声检查对于心内结构、瓣膜运动功能强于CT,而CT对于心外大血管的连接,肺动脉和心室的发育以及冠状动脉起源、走形,气管的的异常等判断远远优于超声检查。MSCT对于复杂先天性心脏病一期术后了解肺动脉和心室的发育,大血管矫治的判断显示直观、清晰,可重复性强,可作为术后复查的一线检查手段。

Objectives To evaluate the clinic value of MSCT for congenital heart diseases postoperatively. Methods In retrospect of clinical data in 21 cases with congenital heart diseases including CT and US, preoperative and postoperative（average interval of time 1. 5 3years）. Statistical methods are employed to compare their McGoon ratio and left ventricu- lar end-diastolic volume （LVEDV） individually ,along with the patency of aortopulomonarv collateral arteries, which can be helpful in deciding when to take the second procedure. Results of the 21 cases,3 DORV ,4 TOF, 3 pulmonary artesian, 2 single ventricle,2 tricuspid atresia,3 aortic coarctation ,3 complete transposition of ~reat arteries. One-stage operation were performed in 15 cases because of the pulmonary artery hypoplasia, such as modified Blalock-Taussing shunt ,bidirectional pulsatile Glenn shunt. 7cases performed surgical repair＋Interventional device closure,5 cases performed completion Fontan procedure, their McGoon ratio and LVEDV individually along with the patency of aortopulomonarv collateral arteries preoperatively and postoperatively.There were significant difference between CT and US. The aortic arteries and collateral vessels were ~reatly improved after surgery in 3 aortic coarctation patients.the effect postoperational were also satisfied in patients with complete transposition of great arteries.however one patient with pulmonary atresia had haemoptysis without clear cause 7years after bidirectional pulsatile Glenn shunt, and CT shows a pulmo- nary arteriovenous fistula. Conclusions US is better than CT in recognizing the inner structure of the heart ,the valvular structure and function CT shows it significant advantage in reco^fizing ventricular-arterial junction, the development of pulmonary artery and ventricle, the origin and process of coronary artery, tracheal abnormalities.MSCT can be an initial method in the postoperative examination of congenital heart disease.