婴幼儿圆锥动脉干畸形并冠状动脉异位起源MSCT诊断与手术复杂程度相关性分析

Correlation analysis of MSCT diagnosis and surgical complexity in infants with conus trunk malformation and ectopic coronary artery

目的:研究婴幼儿圆锥动脉干畸形合并冠状动脉异位起源各类型发生率、构成比,通过回归分析探讨圆锥动脉干畸形合并冠状动脉脉异位起源的MSCT分类对手术复杂程度的预判能力。方法:回顾性分析520例经手术证实的婴幼儿圆锥动脉干畸形,所有患儿均在广东省妇幼保健院行MSCT心脏成像并记录圆锥动脉干畸形、冠状动脉异位起源类型及数量。对不同类型圆锥动脉干畸形合并冠状动脉异位起源的发生率及构成比分别采用行×列Pearson卡方检验进行比较,使用Logistic回归对手术复杂程度相关指标的预测能力进行分析,与手术结果对照探讨术前MSCT心脏成像诊断对手术复查程度的预测能力。结果:婴幼儿圆锥动脉干畸形共520例,合并冠状动脉异位起源者91例,平均发病率为17.5%,其中肺动脉闭锁(PA) 23例,大动脉转位(TGA) 27例,法洛氏四联症(TOF) 11例,永存动脉干(PTA) 9例,右室双出口(DORV)21例。在本组圆锥动脉干畸形合并不同类型冠状动脉异位起源中单冠状动脉(SCA)最多,占61.53%,其次为对侧冠状动脉或无冠窦起源(OO)占23.07%,冠状动脉多发起源(MO)9.89%,冠状动脉高位起源(HO) 4.39%,冠状动脉肺动脉起源(PO)最少,占1.09%。采用行×列Pearson卡方检验,卡方值为27.859,P=0.033,说明不同类型圆锥动脉干畸形的冠脉异位起源构成比不全相同即不同类型圆锥动脉干畸形与冠脉异位起源有关联性。本研究冠状动脉异位起源发生率由高到低依次为PTA(39.13%)>TGA(28.12%)>DORV(22.10%)>PA(17.16%)>TOF(6.35%)。Logistic回归显示右心室双出口、大动脉转位、对侧冠状动脉或无冠窦起源联合对手术复杂程度有最好的预测效能。结论:圆锥动脉干畸形合并冠状动脉异位起源的MSCT诊断可有效预测手术复杂程度;当心脏MSCT诊断大动脉转位或者右心室双出口时,因涉及动脉调转术而致手术复杂程度增加,如果合并单冠状动脉或对侧冠状动脉异位起源,近端冠状动脉的游离、松解难度增大致动脉调转术中冠状动脉移植失败的风险增加,影响预后;术前必须明确圆锥动脉干畸形类型及伴发冠状动脉异位起源的类型,详细了解冠状动脉起源及其近段走行状态,降低冠状动脉移植风险及改善预后。

Objective:To study the incidence and composition ratio of various types of congenital trunk malformation combined with coronary ectopic origin in infants and young children,and through regression analysis,to explore the prediction of the complexity of the operation by MSCT diagnosis of congenital trunk malformation combined with coronary artery ectopic origin ability.Methods:A retrospective analysis of 520 cases of conical arterial trunk malformation confirmed by surgery.All children underwent MSCT cardiac imaging at Guangdong Maternal and Child Health Hospital,and the types and number of origins of conical arterial trunk malformation and coronary artery ectopic were recorded.The incidence and composition ratio of different types of congenital trunk malformation combined with coronary ectopic origin were compared employing row×column Pearson chi-square test.Multiple regression was used to explore potential indicators that affected the complexity of surgery.Logistic regression was used to evaluate the complexity of surgery.The predictive power of related indexes was analyzed and compared with the surgical results to explore the predictive power of preoperative MSCT cardiac imaging diagnosis for the degree of surgical review.Results:There were 520 cases of conical artery malformation in infants and 91 cases with ectopic coronary origin.The average incidence was 17.5%,including 23 cases of pulmonary atresia PA,27 cases of transposition of the great arteries,and tetralogy of Fallot TOF.In 11 cases,9 cases of permanent arterial trunk PTA,21 cases of right ventricular double outlet DORV.In this group of conical artery malformations with different types of coronary ectopic origins,single coronary artery SCA accounted for the most,accounting for 61.53%,followed by contralateral coronary artery or non-coronary sinus origin OO,accounting for 23.07%,and coronary artery multi-originated MO accounted for 9.89%,the high origin of the coronary artery HO was 4.39%,and the coronary pulmonary artery originated the least PO,accounting for 1.09%.Using row×column Pearson chi-square test,the chi-square value was 27.859,and the P value was 0.033.So,the different types of conical artery malformations had different origins of coronary artery ectopic composition ratio,hat was,different types of conical artery malformations and coronary ectopic coronary artery.The origin is related.The incidence of coronary ectopic origin in this study was PTA(39.13%)>TGA(28.12%)>DORV(22.10%)>PA(17.16%)>TOF(6.35%).Logistic regression showed that the combination of double right ventricular outlet,transposition of the great arteries,contralateral coronary artery or non-coronary sinus origin had the best predictive power for the complexity of surgery,indicating that the different types of conical artery malformations have different origins of coronary artery ectopic composition ratio,that was,different types of conical artery malformations and coronary ectopic coronary artery.The origin was related.The incidence of coronary ectopic origin in this study was PTA(39.13%)>TGA(28.12%)>DORV(22.10%)>PA(17.16%)>TOF(6.35%).Logistic regression showed that the combination of double right ventricular outlet,transposition of the great arteries,contralateral coronary artery or non-coronary sinus origin had the best predictive power for the complexity of surgery,indicating that the different types of conical artery malformations had different origins of coronary artery ectopic composition ratio,that was,different types of conical artery malformations and coronary ectopic coronary artery.The origin was related.The incidence of coronary ectopic origin in this study was PTA(39.13%)>TGA(28.12%)>DORV(22.10%)>PA(17.16%)>TOF(6.35%).Logistic regression showed that the combination of double right ventricular outlet,transposition of the great arteries,contralateral coronary artery or non-coronary sinus origin had the best predictive power for the complexity of surgery.The incidence of coronary ectopic origin in this study was PTA(39.13%)>TGA(28.12%)>DORV(22.10%)>PA(17.16%)>TOF(6.35%).Logistic regression showed that the combination of double right ventricular outlet,transposition of the great arteries,contralateral coronary artery or non-coronary sinus origin had the best predictive power for the complexity of surgery.The incidence of coronary ectopic origin in this study was PTA(39.13%)>TGA(28.12%)>DORV(22.10%)>PA(17.16%)>TOF(6.35%).Logistic regression showed that the combination of double right ventricular outlet,transposition of the great arteries,contralateral coronary artery or non-coronary sinus origin had the best predictive power for the complexity of surgery.Conclusion:The MSCT diagnosis of conical artery malformation combined with ectopic coronary artery can effectively predict the complexity of surgery;when cardiac MSCT diagnoses transposition of the great arteries or double right ventricular outlet,the complexity of the surgery increases due to arterial switch surgery.If combined with single coronary,the origin of the artery or the contralateral coronary artery is ectopic,and the difficulty of the free and loosening of the proximal coronary artery increases,which increases the risk of coronary artery graft failure during arterial switch surgery and affects the prognosis;the type of conical artery malformation and its associated Types of ectopic origin of coronary artery,learn more about the origin of coronary artery and its proximal course,reduce the risk of coronary artery transplantation and improve the prognosis.