冠状动脉CT血管成像诊断无顶冠状静脉窦综合征的临床价值

Clinical value of cardiovascular CT angiography in diagnosis of unroofed coronary sinus syndrome

目的探讨冠状动脉CT血管成像(CCTA)在无顶冠状静脉窦综合征(URCS)诊断和亚分类中的作用,为该病的外科学治疗提供影像学资料。方法回顾性分析5例经手术确诊的URCS患者的资料,并复习既往文献报道,根据冠状静脉窦(CS)的缺陷部位和大小,将URCS分为4种类型:Ⅰ型为完全缺损;Ⅱ型为近端冠状静脉窦部分缺损;Ⅲ型为远端冠状静脉窦部分缺损;Ⅳ型为变异型。然后根据左上腔静脉(LSVC)的存在情况,将URCS上述每种类型分为a、b两种亚型。结果5例患者均行CCTA及超声心动图检查,超声心动图检出3例URCS,CCTA检出5例URCS,其中Ⅰa型2例,Ⅰb型1例,Ⅱb型1例,Ⅳa型1例。5例患者均合并有其他先天性心脏畸形。超声心动图检测URCS的敏感性明显低于CCTA。结论CCTA及影像学重建简单易行,可对心脏、大血管、冠状窦提供良好的解剖学描述,对URCS的诊断和治疗有重要的临床意义。

Objective To evaluate the clinical value of cardiovascular CT angiography(CCTA)in the diagnosis and subcategorization of unroofed coronary sinus syndrome(URCS).Methods The clinical data of 5 patients with URCS were retrospectively analyzed.Based on the defect location and size of coronary sinus(CS),URCS was divided into four types:complete defect(typeⅠ),partial defect of proximal CS(typeⅡ),partial defect of distal CS(typeⅢ),and variants(typeⅣ).According to presence of left superior vena cava(LSVC),each of the above 4 types was divided into 2 subtypes as type a and type b.Results All the 5 patients underwent CCTA and echocardiography.URCS were detected in 3 cases by echocardiography and 5 cases by CCTA,including 2 cases of typeⅠa,1 case of typeⅠb,1 case of typeⅡb,and 1 case of typeⅣa.All the 5 patients had other congenital heart malformations.The sensitivity of echocardiography in detecting URCS was significantly lower than CCTA.Conclusion CCTA and imaging reconstruction can provide excellent anatomical delineation of the heart,great vessels,and CS.And it is simple and easy to use,which has important clinical implications for precise diagnosis and treatment.