256层螺旋CT评价胸廓内动脉与冠状动脉的解剖学关系

The anatomical relationship of the internal thoracic artery and coronary artery evaluated by 256 slice spiral CT

目的应用256层螺旋CT血管造影术评价自体胸廓内动脉与冠状动脉的解剖学关系。方法分析200例因胸痛行胸主动脉及冠状动脉造影检查患者的血管造影图像,测量两侧胸廓内动脉及冠状动脉各主要分支的长度、内径,以及主动脉-冠状动脉搭桥长度等解剖学参数数值。结果胸廓内动脉内径为(2.52±0.38)mm,胸廓内动脉自起点至终端长度为(190.12±1.90)mm。两侧胸廓内动脉管腔内径及长度比较差异均无统计学意义。冠状动脉前降支、左旋支、对角支、右冠状动脉及后室间支内径分别为(2.82±0.25)、(2.60±0.12)、(2.22±0.25)、(3.02±0.27)和(2.35±0.35)mm,除右冠状动脉内径高于胸廓内动脉内径外,其余与胸廓内动脉内径差异均无统计学意义。游离移植于升主动脉起始部上方2 cm搭桥至前室间支中点、沿左旋支途径搭桥至房室交点、沿右冠状动脉途径搭桥至房室交点弧形长度和自房室交点至后室间支中点长度均低于胸廓内动脉长度(P<0.05);原位移植除自胸廓内动脉起始部至前降支中点弧形长度与胸廓内动脉长度比较差异无统计学意义,至左旋支房室交点、至右冠状动脉房室交点弧形长度均高于胸廓内动脉长度(P<0.05)。结论胸廓内动脉与冠状动脉主要分支内径接近,原位移植适用于心前壁血管,用游离胸廓内动脉移植,其长度可满足桥接升主动脉与任何冠状动脉。

Objective To evaluation the anatomy relationship between thoracic artery and coronary artery by using 256 layer spiral CT angiography. Methods The angiographic images of thoracic aortic and coronary artery angiography were revealed in 200 patients with chest pain. Values of the major branch length, diameter, length of the aorta-coronary artery bypass on both sides of the thoracic artery and coronary artery were measured. Results The diameter of thoracic artery was （2.52±0.38） mm, and the length of thoracic artery from the starting point to terminal was （190.12 ±1.90） mm. There were no significant differences in the thoracic artery lumen diameter and length between both sides. The inner diameters of left anterior descending coronary artery, left circumflex, diagonal branch, right coronary artery and the posterior interventricular branch were （2.82 ±0.25）, （2.60±0.12）, （2.22±0.25）, （3.02±0.27） and （2.35±0.35） mm respectively. There were no significant differences in thoracic artery diameters except for the right coronary artery diameter, which was higher than that of the thoracic artery. About free transplantation the length from 2cm above in the ascending aorta starting to the halfway point of anterior descending coronary artery, to the atrioventricular node along the left circumflex way, to the atrioventricular node along the right coronary artery and from the atrioventricular node to halfway point of posterior interventricular branch was shorter than that of thoracic artery （P〈0.05）. About situ transplantation in addition to the length from the thoracic artery start department to the point of anterior descending compared with the thoracic artery length, there were no statistical significance （ P〉0.05）. The length from the thoracic artery start department to the left-hand atrioventricular node, to the right coronary artery atrioventricular node was higher than that of the thoracic artery length （P〈0.05）. Conclusion The branches of internal thoracic artery and coronary artery are similar. About situ transplantation is suitable for the wall blood vessels before the heart. With free thoracic artery transplantation, its length can meet any bridging from the ascending aorta to the coronary arteries.