肺静脉及左心房CT三维重建技术在非瓣膜性心房颤动患者射频消融中的应用价值

Application of pulmonary vein and CT left atrial reconstruction in radiofrequency ablation in patients with non-valvular atrial fibrillation

目的 探讨肺静脉及左心房CT三维重建技术在指导非瓣膜性心房颤动患者射频消融中的价值。方法 回顾性收集2019年1月至2021年1月30例非瓣膜性心房颤动患者拟进行射频消融治疗前行冠状动脉CT血管造影(CTA)检查影像学资料,三维重建观察分析左心房形态及容积、肺静脉解剖与变异、左心耳开口与左上肺静脉开口的解剖关系。结果 30例患者中,7例左心房顶部形态为平坦型(23%),18例为隆起型(60%),5例为凹陷型(17%);测得患者左心房平均容积为(72.9±4.6)mm^(3)。30例患者中肺静脉变异患者8例(27%),左上肺静脉开口距左心耳开口距离为(3.2±1.4)mm,左下肺静脉开口距左心耳开口距离为(7.0±2.1)mm,二者差异有统计学意义(P<0.05);左上肺静脉直径为(22.73±0.18)mm,左下肺静脉直径为(17.24±0.22)mm,二者差异有统计学意义(P<0.05);左肺静脉间距为(5.6±1.2)mm,右肺静脉间距为(5.8±1.2)mm,二者差异无统计学意义(P>0.05)。30例患者中18例(60%)患者左上肺静脉开口与左心耳开口高度一致,8例(27%)患者高于左心耳开口,4例(13%)患者低于左心耳开口。30例患者中左心耳呈鸡翅型11例(36%),菜花型8例(27%),仙人掌型6例(20%),风向袋型5例(17%)。结论 肺静脉及左心房CT三维重建技术能够系统评估左心房、左心耳及肺静脉三者之间的三维立体空间关系,明确解剖与变异,为保证射频消融手术成功及安全提供重要参考依据。

Objective To explore the value of three-dimensional reconstruction of CT pulmonary vein and left atrium in guiding radiofrequency ablation of non-valvular atrial fibrillation(AF).Methods Retrospectively collect Medical Imaging the imaging data of advanced coronary computed tomography angiography(CTA)examination in 30 non-valvular AF patients from January 2019 to January 2021,the anatomical relationship between left atrial morphology and volume,pulmonary vein anatomy and variation,left atrial ear opening and left upper pulmonary vein opening were analyzed.Results Of the 30 patients,7 left atrial roof morphology was flat(23%),18 were bulged(60%)and 5 were depressed(17%).The mean volume of left atrium was(72.9±4.6)mm^(3).Of the 30 patients,8(27%)with pulmonary venous variation,and the distance between the left upper pulmonary vein opening and left atrial appendage opening was(3.2±1.4)mm,the distance between the left lower pulmonary vein opening and left atrial appendage opening was(7.0±2.1)mm,the difference was statistically significant(P<0.05).The diameter of the left upper pulmonary vein was(22.73±0.18)mm,and the diameter of the left lower pulmonary vein was(17.24±0.22)mm and the differences have statistical significance(P<0.05).The left PV spacing was(5.6±1.2)mm and the right PV spacing was(5.8±1.2)mm,two difference was not statistically significant(P>0.05).Of the 30 patients,18(60%)had the same left pulmonary vein opening as the left atrial appendage opening,8(27%)higher than the left atrial ear opening,and 4(13%)lower.Of the 30 patients,the left atrial appendage showed chicken wing type in 11 cases(36%),8 cases of cauliflower pattern(27%),cactus type in 6 cases(20%),wind vane bag type in 5 cases(17%).Conclusion 3D reconstruction technique CT pulmonary vein and left atrium can systematically evaluate the three-dimensional spatial relationship between the left atrium,left atrial appendage,and pulmonary vein,clarify anatomy and variation,and provide an important reference for the success and safety of radiofrequency ablation.