通过多层螺旋CT对慢性心力衰竭患者冠状静脉解剖变异的观察研究

Observation and study on the anatomic variation of coronary vein in patients with chronic heart failure by multi-slice spiral CT

目的通过多层螺旋CT三维重建技术观察与分析心脏再同步化治疗相关血管的解剖特征及变异情况。方法入选162例拟行心脏再同步化治疗的慢性心力衰竭患者,术前行冠状动脉CT成像明确冠状动脉病变,同时行冠状静脉CT三维重建,评估成像质量,并观察与心脏再同步化治疗相关的冠状静脉侧支及冠状静脉窦口的解剖特征及变异情况。结果162例入选患者均完成了冠状静脉CT三维重建。对心脏再同步化治疗相关血管的成像质量分析表明,冠状静脉窦口的成像质量最佳,其次分别为后侧静脉、侧静脉及前侧静脉,而且上述与心脏再同步化治疗相关的血管存在较大的解剖变异。其中存在3支血管的占19.8%,存在2支血管的占35.8%,只有1支血管的占40.7%,而上述血管缺如的占3.7%。结论慢性心力衰竭患者的冠状静脉系统,尤其与心脏再同步化治疗相关的静脉侧支血管存在较大的解剖变异,冠状静脉CT三维重建对术前评估及术中决策具有一定的临床价值。

Objective To observe and analyze the anatomical features and variation conditions of blood vessels related to cardiac resynchronization therapy by three-dimensional reconstruction technology of multi-slice spiral CT.Methods One hundred and sixty-two patients with chronic heart failure undergoing cardiac resynchronization therapy were enrolled,preoperative coronary CT imaging was performed to confi rm coronary artery lesions,at the same time,three-dimensional reconstruction of coronary vein CT was performed to evaluate the imaging quality.And the anatomical features and variation conditions of lateral branches of the coronary veins and coronary sinus ostium related to cardiac resynchronization therapy were observed.Results All 162 patients who were enrolled in the study completed three-dimensional reconstruction of coronary vein CT.The imaging quality analysis of blood vessels related to cardiac resynchronization therapy showed that the image quality of the coronary sinus ostium was the best,followed by the posterolateral,lateral and anterolateral veins.Moreover,there were large anatomic variations in the blood vessels related to cardiac resynchronization therapy,among which,three veins appeared in target area accounted for 19.8%,two veins accounted for 35.8%,single vein accounted for 40.7%,no veins accounted for 3.7%.Conclusions There is a large anatomical variation of coronary venous system of patients with chronic heart failure,especially collateral veins related to cardiac resynchronization therapy.The three-dimensional reconstruction of coronary vein CT may have certain clinical value on the preoperative evaluation and intraoperative decision making.