左心耳封堵术MSCT三维成像测量可行性分析和临床应用

MSCT three-dimensional imaging measurement for percutaneous transcatheter left atrial appendage occlusion: feasibility analysis and clinical application

目的采用心电门控多层螺旋CT（MSCT）三维成像技术重建心房颤动（AF）患者左心耳并进行测量，探讨其在经皮左心耳封堵术（PCLAA）中应用的可行性和临床价值。方法人选AF患者27例，年龄43～80岁，平均（67．3±11．5）岁；非瓣膜性AF25例，瓣膜性AF2例。15例完成PCLAA术。术前行心电门控MSCT检查，通过AW4．4后处理工作站重建左心耳三维结构．空间向量测量左心耳开口长短径及深度，与术中经食管超声心动图（TEE）测量作比较，选择合适尺寸左心耳封堵器及植入位置．植入左心耳颈部。术后3个月TEE复查左心耳和（或）MSCT三维重建。结果AW4．4后处理工作站重建下．外测法测量左心耳开口长径与封堵器最终选择有显著相关性（r=0．968），差异无统计学意义（P〉0．05）；内侧法与封堵器最终选择有相关性（r=0．897），差异无统计学意义（P〉0．05）。15例手术患者随访3个月，TEE或CT三维重建复查均未见血流渗漏。结论心电门控MSCT三维成像技术能够重建AF患者左心耳三维结构,为PCLAA术前提供封堵器植入重要数据，也为术后随访提供可靠依据，具有临床可行性及应用价值。

Objective By sing ECG-gating multi-slice computed tomography （MSCT） three-dimensional （3D） imaging technology to reconstruct and to measure the left atrial appendage （LAA） in patients with atrial fibrillation （AF）, to discuss its feasibility and its clinical application in percutaneous closure of LAA （PCLAA）. Methods A total of 27 AF patients with a mean age of （67.3±11.5） years old （43-80 years old） were enrolled in this study. Non-valvular AF was diagnosed in 25 patients and valvular AF was diagnosed in 2 patients. PCLAA was accomplished in 15 patients; on AW4.4 post-processing workstation 3D imaging of LAA was reconstructed, the long and short diameters and depth of LAA orifice were determined with spatial vector measurement method, the data were compared with the results of trans- esophageal echocardiography （TEE） measurement method. The appropriate sized LAA oceluder and the optimal implantation position were selected, the LAA oecluder was implanted at the neck of LAA. Three months after the treatment, reexamination of LAA was performed with TEE and/or MSCT 3D reformation. Results With the help of imaging reformation on AW4.4 post-processing workstation, the long diameter of LAA orifice determined by outside measure method was closely correlated with the final selection of the oceluder （r=0.968）, and no statistically significant difference existed between the two groups （P〉0.05） ; while long diameter of LAA orifice determined by inside measure method bore a certain correlation with the final selection of the occluder （r= 0.897）, and the difference between the two groups was not statistically significant （P〉0.05）. Fifteen patients were followed up for three months, no blood flow leakage was observed on TEE or CT 3D reformation imaging in all patients. Conclusion ECG-gating MSCT 3D reformation technique can reconstruct 3D structure of LAA in AF patients, which provides important information for the implantation of oceluder before the performance of PCLAA, and also provides reliable basis for postoperative following-up. Therefore, this technique has the clinical feasibility and the application value.