双源CT在DeBakeyⅠ型主动脉夹层瓣膜置换术后抗凝对残余管腔重塑效果中的诊断应用

2 Clinical application of dual-CT in the effect of anticoagulation on the remodeling of residual lumen after aortic valve replacement of De Bakey type I aortic dissection

目的探讨双源CT低剂量回顾性心电门控CTA检查在De BakeyⅠ型主动脉夹层瓣膜置换术后抗凝残余管腔重塑效果中的诊断应用价值。方法回顾性分析我院30例De BakeyⅠ型患者的临床资料,分为A、B两组,A组(非换瓣组)19例,行"孙氏"手术;B组(换瓣组)11例,行"孙氏"手术+主动脉瓣置换术;所有患者术前及术后3~6个月均行双源CT低剂量回顾性心电门控CTA检查,测量腹腔干、肠系膜上动脉及双肾动脉根部水平主动脉真腔及相应水平腹主动脉直径,比较术前及术后换瓣组与非换瓣组在各水平真腔与腹主动脉的比值有无差异,间接评价主动脉夹层术后残余管腔的重塑效果。结果非换瓣组患者年龄及合并高血压、冠心病的发生率高于换瓣组,差异有统计学意义(P值分别为0.004、0.001、0.023);换瓣组合并马凡综合征的发生率高于非换瓣组,差异有统计学意义(P=0.003);非换瓣组与换瓣组分别在术前及术后腹腔干、肠系膜上动脉及双肾动脉根部水平真腔与腹主动脉的比值差异无统计学意义(非换瓣组P值分别为0.09、0.122、0.287;换瓣组P值分别为0.608、0.435、0.806)。结论术前是否累及主动脉瓣对主动脉夹层术后以远残余管腔的重塑无明显影响;双源CT主动脉CTA检查是一种可靠的诊断主动脉夹层瓣膜置换术后残余管腔重塑效果的检查方法。

Objective To investigate the clinical application of low dose retrospective ECG-gated CTA in the effect of antico- agulation on the remodeling of residual lumen after aortic valve replacement of DeBakey type I aortic dissection. Methods A to- tal of 30 patients with DeBakey type I aortic dissection underwent ECG-gated double source CTA. Those patients were divided into two groups, group A（ n = 19 ） who underwent surgical repairs with total arch replacement and modified stented elephant trunk tech- nique （Sun＇ s Operation） and, group B（ n = 11 ）, who underwent surgical repairs with Sun＇ s Operation and aortic valve replace- ment. About 3 to 6 months ＇after surgery, aortic CTA examination was obtained, the diameter of the true lumen and aorta in the level of the celiac trunk, superior mesenteric artery and renal artery in each phase were measured. The pre-operative and postoper- ative ratio of trne lumen and aorta were cah,＇ulated and the remodeling of residual lumen indirectly was eompared. Results The age, the incidence of＂ hypertension and coronary heart disease in patients with non-valve replacement group were higher than the valve replacement group （ P =0. 004, 0. 001, 0. 023 ）. But in the incidence of Mar/hn＇ s syndrome , the results were reversed （ P = 0. 003 ）. There was no significant ditference in the preoperative and postoperative ratio of the true lumen and aorta diameter in the three levels between the two groups. Conclusion Whether the aortic valve is involved, there has no difference in the remode- ling of residual hnnen. Low dose retrospective ECG-gated double souree CTA provides high diagnostic accuracy for the remodeling of residual lumen after am＇tic valve replacement of DeBakev type I aortic dissection.