CARTO-3三维重建在心房颤动患者左心耳解剖形态评价中的应用

The application of three-dimensional reconstruction using CARTO-3 in the morphological assessment of left atrial appendage with atrial fibrillation

目的:探讨CARTO-3三维重建在心房颤动(房颤)患者左心耳解剖形态评价中的应用价值。方法:回顾性研究2014年8月至2015年9月89例接受射频消融术的房颤患者,所有患者进行64排螺旋CT增强扫描,应用CARTO-3对左心房、左心耳、肺静脉进行三维重建,测量左心耳口横径、左心耳深度以及左心耳口至左上肺静脉的距离等参数,对左心耳解剖形态进行相关分型。结果:运用CARTO-3三维重建技术,患者左心耳口形态分型:椭圆形76例(85.4%),足形6例(6.7%),类圆形4例(4.5%),水滴形3例(3.4%);左心耳形态分型:鸡翅型37例(41.6%),菜花型32例(36.0%),仙人掌型10例(11.2%),风向标型10例(11.2%);左心耳口平均最大横径为(30.1±6.7)mm,左心耳平均深度为(38.3±9.3)mm,左心耳口至左上肺静脉的平均距离仅为(5.9±3.9)mm。结论:CARTO-3三维重建可对左心耳及其相邻结构提供直观的解剖参考,并可定量评价左心耳解剖参数,对左心耳封堵术具有较好的指导意义。

Objective： To explore the application value of three-dimensional reconstruction by CARTO-3 in the morphological assessment of left atrial appendage （LAA） with atrial fibrillation （AF）. Methods： Eighty-nine AF patients who received transcatheter radiofrequency ablation were reviewed from Augest 2014 to September 2015 in our center. All involved patients underwent contrast-enhanced CT angiography. Three-dimensional reconstruction of left atrium, LAA and pulmonary veins was performed by CARTO-3. After all images were post-processed, data were measured and the morphology of LAA was classified into different types. Results： LAA ostium was classified into four types： oval （76, 85.4%）, foot-like （6, 6. 7%）, round-like （4, 4. 5%） and drop-like （3,3.4%）. LAA morphology was classified into four types： chicken-wing （37, 41. 6%）, cauliflower （32, 36. 0%）, windsock （ 10, 11.2%） and cactus （10, 11. 2%）. The average maximal diameter of LAA ostium was （30. 1 ± 6. 7） rnm, the average LAA depth was （38. 3 ± 9. 3） ram, and the average distance between LAA ostium and left superior pulmonary vein was just （5. 9 ± 3. 9） rnm. Conclusion： Three-dimensional reconstruction by CARTO-3 can provide intuitive reference to the anatom of LAA and its adjacent structures, and quantitative evaluation of LAA anatomical parameters, which may have a nice significance in the direction of LAA occlusion.