中老年房间隔缺损的心脏CT与经食管超声评估对比研究

Evaluation of atrial septal defect using cardiac computed tomography compared with two-dimensional transesophageal echocardiography

目的：探讨心脏CT血管成像（CTA）在评估房间隔缺损（ASD）方面的精确性及对介入治疗的指导价值。方法：回顾性分析已行ASD封堵术或手术修补的中老年患者63例资料,男性18例,女性45例,年龄50~77岁,平均（56.9±5.8）岁,患者均于术前行经胸超声（TTE）和经食管超声（TEE）检查,并常规行CTA检查以除外冠心病。在GE工作站上行ASD三维（3D）重建,以CT横断面辅助测量技术（CTAS）测量缺损大小及边缘长度,与TTE及TEE对比,并总结其他重要影像学表现。结果：在缺损大小方面,CTA与TTE及TEE分别相差约4.48（3.28~5.76）mm和1.98（0.94~3.03）mm;CTA与TTE及TEE之间有良好的相关性,且与后者相关性最强;在房间隔长度及缺损边缘方面,除下腔侧边缘外,CTA及TEE测量值均差异无统计学意义;CTA所测下腔侧边缘长度较TEE测量值约〉2.2（1.35~3.08）mm;15例患者因CTA提供重要解剖信息而改变治疗方案,其中13例患者行外科手术治疗,2例于介入封堵ASD同时行冠状动脉成形及支架置入术。结论：对于拟行ASD封堵术的中老年患者,术前心脏CT检查可准确测量缺损大小及边缘长度,且在评估下腔侧边缘方面可能优于TEE。

Objective ： To investigate the accuracy of cardiac CT angiograph in assessment of atrial sep- tal defect. Methods ： Sixty-three adult patients [ 16 males, 47 females, aged from 50 to 77 years, mean age （56. 41 ±5.64） years I who underwent successful transeatheter closure of ASD-II （50） or surgery （ 13 ） were enrolled in this study. Transthoracic echocardiography （TIE） and transesophageal echocardiography （TEE） were performed to select suitable cases for device closure, and followed by Coronary CT angiography examination for detection of associated cardiovascular diseases. Defect size and rim tissue were measured on ASD threedimensional （3 D） reconstruction imaging sections obtained in the GE-workstation, and CT axial sequence assisted volumetric measurement（CTAS） were used for calculating the major axis and the minor axis of the ASD respectively; in the same way, the ASD rims and the atrial septal length （ASL）were measured. Paired Samples Test and correlation was calculated between CTA measurement, TIE and TEE. Results：For ASD size, mean differences were 4.48 （ 3.28 - 5.76） mm and 1.98 （ 0. 94 - 3.03 ） mm compared CTA imaging with TFE and TEE; A better correlation on ASD measurements was found between CT size and TI＇E and TEE, the stronger correlation was found between CT size and TEE; for defect rims and septal length, there were no significant differences between the measurements at CTA imaging and TEE or surgical results except for IVC rim, IVC rim length was overestimated at TEE versus CTA imaging, mean difference 2. 2mm（3. 08-1. 35 ）, Rim distance to mitral valve and coronary sinus was easy to assess; Additional information were identified in 15 patients （27 % ） by Cardiac CT which resulted of the clinical management alteration, including that 13 case were referred to surgery and 2 cases for percutaneous coronary angioplasty （PTCA） together with thanscatheter ASD closure. Con- clusion：Cardiac CT can enable determination of defect size, rim distances to adjacent structures, and may be superior to TEE in evaluation of inferior vena cava rim.