先天性左冠状动脉主干闭锁的Revolution CT诊断

Diagnosis of Congenital Left Main Coronary Artery Atresia with Revolution CT

目的探讨Revolution CT对先天性左冠状动脉主干闭锁的诊断价值。方法回顾性分析2012年2月至2019年3月我院收治的6例先天性左冠状动脉主干闭锁患者的资料,男女各3例;年龄10个月至48岁,体重7.7~55 kg。采用GE公司Revolution CT扫描仪进行前瞻单心跳收缩期(45%~50%)扫描成像。5例婴幼儿于基础麻醉及自由呼吸状态下行冠状动脉扫描,1例成人患者在清醒状态及屏气条件下进行检查。所有CT图像均由放射影像科2名具有5年以上心血管影像阅片经验的医师在AW4.6工作站进行阅读和评估。诊断结果与心血管造影结果作对比。结果Revolution CT成像显示所有患者右冠状动脉均开口于主动脉右冠状动脉窦,5例患者诊断为先天性左冠状动脉主干闭锁,1例患儿可疑左冠脉主干开口闭锁或狭窄。所有患者左心房室均有扩大,2例患者二尖瓣下腱索走行区可见钙化。3例患者行手术治疗并证实为左冠脉主干闭锁,其中2例婴幼儿患者左主干开口及近段闭锁,1例成人患者左主干开口闭锁。结论Revolution CT检查可在低辐射剂量条件下显示冠状动脉及心脏的病理解剖学信息,对绝大多数的先天性左冠脉主干闭锁患者可做出明确诊断。

Objective To evaluate the diagnostic value of Revolution CT in patients with congenital left main coronary artery atresia.Methods Six patients were diagnosed as congenital left main coronary artery atresia in our hospital from February 2010 to March 2019.There were 3 males and 3 females with age ranged from 10 months to 48 years and weight ranged from 7.7 kg to 50 kg.GE Revolution CT scanner was used for prospective single-heartbeat systole(45%-50%)scan imaging.The scanning was performed in 5 infantile patients with free breathing under basal anesthesia and in the adult patient with breath holding under local anesthesia.All the medical images were assessed independently by two radiologists with over 5-year experience in imaging diagnosis of cardiovascular disease.All the diagnosis by CT were finally confirmed by conventional angiocardiography.Results On Revolution CT study,the right coronary artery originated from the right coronary sinus of Valsalva in all the patients.Congenital left main coronary artery atresia was confirmed in 5 patients.In 1 patient stenosis or atresia of the ostium of left main coronary artery was uncertain.Revolution CT demonstrated that the left atrium and ventricle were enlarged in all the patients and calcification was found in the area of mitral chordae tendons in 2 patients.Three patients received surgical treatment.In the intraoperative exploration,atresia of the ostium and proximal segment of left main coronary artery was confirmed in 2 infantile patients and ostial atresia of left main coronary artery was confirmed in the adult patient.Conclusion Revolution CT can be used in the definite diagnosis in most patients with left main coronary main artery atresia.