经胸超声心动图检测冠状窦的临床研究

Evaluation of coronary sinus by transthoracic echocardiography

目的 探讨经胸超声心动图 (TTE)检测冠状窦的可行性 ,确定冠状窦的正常值以及影响因素。方法 与逆行冠状窦造影对比以确定TTE评价冠状窦形态和大小的准确性 ;观测 15 2例正常人和 316例心血管病患者的冠状窦形态和大小并分析年龄、性别及心脏形态改变对其的影响。结果 TTE对冠状窦的观测成功率为96.7% ,在形态分类和内径测量方面 ,TTE和血管造影间存在良好的相关性 (r =0 .946,P <0 .0 1) ;正常成年人冠状窦呈管状者占 67.1% ,呈喇叭状者占 32 .9% ;冠状窦入口最大径为 ( 9.1± 2 .8)mm ,并随心动周期呈规律性变化 ,心室收缩末期最大 ,舒张末期最小 ,变化率为 5 0 .9%± 2 2 .7% ;冠状窦形态和大小与性别、年龄无关 ;疾病导致右房扩大时 ,冠状窦内径增大 ,周期性变化率显著减小。结论 TTE能够准确评价冠状窦的形态和大小 。

Objective To explore the feasibility and usefulness of transthoracic echocardiography (TTE) in the evaluation of coronary sinus (CS) and determine the normal values and their related factors.Methods TTE was performed in 490 subjects with CS observed satisfactorily in 474,of whom 6 patients with abnormally dilated CS due to congenital left superior vena cava were excluded and the rest were assigned to two groups: normal control group and cardiovascular diseases group.In normal control group with 152 healthy adults enrolled,the effects of age and gender on CS were studied.In cardiovascular diseases group with 316 patients included,TTE and retrograde CS angiography were performed in 31 patients with recurrent paroxysmal super-ventricular tachycardia and the morphological patterns and diameters of CS at entrance to right atrium were observed and compared.Furthermore,the influence of structure changes of the heart on CS was analyzed.Results CS was visualized satisfactorily in 96.7% of all subjects by TTE.An excellent correlation was found between TTE and angiography on CS diameters and morphological patterns.In normal control group,67.1% showed a tubular pattern while 32.9% with a windsock appearance.Age and gender had no relation with the morphological patterns and diameters of CS.The ostium diameter of CS showed cyclic change with its maximum at end-systole and minimum at end-diastole of ventricle.The variant rate was 50.9% ± 22.7% .In patients with enlarged right atrium,the ostium diameter of CS increased while its variant rate decreased significantly compared with normal group.Conclusions TTE can provide valuable and accurate evaluation of CS and should be taken as a routine modality for pre-intervention examination.