心脏CT血管造影三维重建定量左心耳口部周长选择封堵器型号

目的 观察心脏CT血管造影(CTA)三维重建定量左心耳(LAA)口部周长对选择左心耳封堵术(LAAC)治疗房颤(AF)所用封堵器型号的价值。方法 基于术前心脏CTA三维重建、经食管超声心动图(TEE)及术中LAA造影测量94例接受LAAC AF患者LAA口部最大长径,基于心脏CTA三维重建测量LAA口部周长、计算周长衍生直径(PDD)。分析LAA口部参数与植入封堵器型号的相关性及一致性,评估以各种方法所获LAA口部参数预测与实际植入封堵器型号的一致性;以LAA PDD为预测变量、植入封堵器型号为因变量建立线性回归方程。结果 实际植入封堵器型号(真实直径)为(28.95±3.13)mm,周长为(90.90±9.82)mm。心脏CTA、TEE及术中LAA造影所测LAA口部最大长径分别为(24.63±3.17)mm、(24.07±3.19)mm及(23.17±3.25)mm,均与封堵器型号呈正相关(r=0.814、0.691、0.790,P均<0.001);基于心脏CTA所测LAA口部周长为(78.48±10.69)mm, PDD为(24.98±3.40)mm; LAA口部周长与封堵器...     

双源CT评估心房颤动患者左心房及左心耳结构及功能重构

目的探讨应用双源CT评估心房颤动(AF)患者左心房及左心耳结构及功能改变,分析其与左心耳血栓形成的关系。方法回顾性分析84例AF患者(AF组)及对照组32例的心脏CT资料,以图像后处理软件测量左心房最大、最小容积(LAVmax、LAVmin)及左心耳最大、最小容积(LAAVmax、LAAVmin),计算左心房射血分数(LAEF)及左心耳射血分数(LAAEF)。根据临床症状将AF组患者分为阵发性AF亚组及持续性AF亚组,又根据是否存在左心耳血栓或"血栓前状态"分为AF左心耳血栓阳性亚组及阴性亚组,对左心房及左心耳容积及心功能指标进行统计学分析。结果 AF左心耳血栓两亚组LAVmax、LAVmin、LAAVmax及LAAVmin均明显高于对照组(P均0.05),且AF左心耳阳性亚组LAVmax、LAVmin、LAAVmax及LAAVmin均高于阴性亚组(P均0.01);AF左心耳血栓两亚组LAEF及LAAEF均明显低于对照组(P均0.001),且AF左心耳阳性亚组LAEF及LAAEF均低于阴性亚组(P均0.001)。持续性AF亚组LAEF及LAAEF均明显低于阵发性AF亚组(P均0.01),阵发性AF亚组与持续性AF亚组间LAVmax、LAVmin、LAAVmax及LAAVmin差异均无统计学意义(P均0.05)。持续性AF亚组左心耳血栓及"血栓前状态"发生率明显高于阵发性AF亚组[72.41%(21/29)vs 14.55%(8/55),χ2=113.46,P0.001]。结论当AF患者存在左心耳血栓或"血栓前状态"时,左心房及心耳结构及功能重构更明显。     

MSCT后处理技术诊断耳硬化症

目的 观察多层螺旋CT（MSCT）后处理技术用于诊断耳硬化症的价值。方法 回顾性收集47例（92耳）耳硬化症及65例（79耳）非耳硬化症听力障碍患者的临床资料及轴位平扫MSCT,对MSCT原始图像行后处理,包括镫骨、耳蜗多平面重组（MPR）及听骨链曲面重组（CPR）,比较MSCT原始图像及其联合后处理技术诊断耳硬化症的效能。结果 根据MSCT原始图像诊断66耳、联合后处理技术诊断89耳耳硬化症,二者敏感度分别为71.74%和96.74%,诊断准确率分别为81.29%和96.49%,后者均高于前者（P均<0.05）;其特异度（92.41% vs. 96.20%）差异无统计学意义（P>0.05）。结论 联合后处理技术有助于提高MSCT诊断耳硬化症的敏感度和准确率。     

改进后的肾囊肿CT引导下硬化剂治疗术

目的观察改进肾囊肿CT引导下硬化剂治疗术的疗效。方法386例肾囊肿经皮穿刺抽吸乙醇治疗,其中,单纯性肾囊肿243例,多发囊肿113例,双肾均有囊肿30例。囊肿直径1.5~7 cm。用9-14 G穿刺针穿刺抽吸,抽出囊液5~700 ml,注入99.7%无水乙醇保留而不抽出,乙醇量以抽出量的25%~50%计算。结果随访193例(251个囊肿),时间3个月~12个月,囊肿治疗有效率达98%以上,囊腔消失率达87%,并发症仅为局部腰部胀痛,无严重后遗症。结论改进后的CT引导下肾囊肿硬化剂治疗术是一种安全、并发症少,操作简单的有效治疗方法。     

颈静脉球窝高位的CT表现及其发生的影响因素

目的探讨颈静脉球窝高位的CT特点及其发生的影响因素。方法分别筛选100例颈静脉球窝高位患者和100名正常者,回顾性分析年龄、性别、乳突气化等因素对颈静脉球窝高位发生的影响,同时观察其CT表现。结果两组资料年龄、乳突气化情况和侧别差异均有统计学意义（P均〈0.01）,两组性别差异无统计学意义（P=0.78）。结论成人、乳突气化欠佳、右侧发生对颈静脉球窝高位发生有显著性影响,而性别则无显著性影响。     

经导管室间隔缺损封堵术后房室传导阻滞的危险因素

室间隔缺损是常见的先天性心脏病。自应用Amplatzer偏心型膜周部室间隔缺损封堵器治疗室间隔缺损以来,随着封堵器的改进与国产化,经导管室间隔缺损封堵术已在临床广泛开展,房室传导阻滞因其对心功能及远期预后的影响日益受到关注。本文对经导管室间隔缺损封堵术后发生房室传导阻滞的各种危险因素进行综述。     

CT引导下软线爪钩定位肺结节准确性的影响因素

目的 分析CT引导下软线爪钩定位肺结节准确性的影响因素。方法 回顾性分析214例接受CT引导下软线爪钩定位的单发肺结节患者,均于定位后24 h内接受电视胸腔镜手术（VATS）切除肺结节。于CT图像上测量肺内定位爪钩与结节外缘之间的最短距离,以该距离<1 cm为定位准确性较好,≥ 1 cm为准确性较差。采用单因素及多因素logistic回归分析观察CT引导下软线爪钩定位肺结节准确性的影响因素。结果 214枚肺结节均一次性穿刺定位成功,其中189枚定位准确性较好（较好组）、25枚定位准确性较差（较差组）;组间结节深度、（进针处）胸壁厚度、进针深度、穿刺针与水平面的角度及术中针道出血率差异均有统计学意义（P均<0.05）。多因素回归分析结果显示,结节最大径（OR=10.422,P=0.034）、结节深度（OR=0.045,P<0.001）、胸壁厚度（OR=0.635,P=0.029）及穿刺针与水平面的角度（OR=1.044,P=0.009）均为影响准确定位的因素。结论 于CT引导下以软线爪钩定位肺结节时,结节径线和深度、胸壁厚度及穿刺针与水平面的角度均影响其准确性。     

CT扫描对微创经皮肾镜碎石术后疗效的预测价值

目的 探讨临床中术前CT扫描对微创经皮肾镜碎石术后疗效的预测应用价值.方法 采取回顾性方法选取本院2012年1月到2013年12月间的60例微创经皮肾镜碎石术患者的临床资料进行分析,分析手术前CT扫描结石状况,并且依据结石CT值进行分组,观察手术后的效果.结果 ＜750.0HU组患者穿刺次数为(1.0±0.1)次,≥750.0HU组患者穿刺次数为(2.2±0.2)次,＜750.0HU组患者穿刺次数明显的低于≥750.0HU组,差异有统计学意义(P＜0.05).＜750.0HU组患者结石清除率、术后并发症发生率分别为85.7％、3.6％;≥750.0HU组患者结石清除率、术后并发症发生率分别为62.5％、12.5％;＜750.0HU组患者结石清除率高于≥750.0HU组,而＜750.0HU组术后并发症发生率明显的低于≥750.0HU组,差异有统计学意义(P＜0.05).结论 临床中术前CT扫描对微创经皮肾镜碎石术后疗效的预测,在临床中具有较高的应用价值.     

外伤性脾破裂后部分性脾栓塞术术前 和术后不同时期的CT表现

目的分析CT诊断外伤性脾破裂的价值及行部分性脾栓塞术（PSE）后不同时期脾脏的CT表现特点。方法收集30例CT诊断为外伤性脾破裂且接受PSE术的患者资料,并于术后第7天（28例）、第14天（25例）、第30天（30例）、第60天（26例）、第90天（22例）行CT复查。结果术前CT显示：完全性脾破裂15例次,包膜下血肿12例次,脾内血肿10例次,脾单一撕裂伤2例,脾挫伤1例。术后CT随访显示：术后第7天脾脏体积增大,栓塞区密度减低,与被栓塞动脉的供血范围一致;术后14天栓塞区密度进一步减低,与周围正常脾实质分界清晰;术后30天脾脏体积缩小,外形欠规则,可呈波浪状;术后60～90天脾脏进一步缩小,轮廓呈分叶状,脾实质密度趋于均一。结论CT能明确诊断脾外伤（包括分型及分级）,可同时发现扫描范围的合并伤,可以作为脾破裂PSE术后的疗效监测手段。     

MSCT引导下经皮穿刺切割活检准确率的影响因素

目的分析影响MSCT引导下经皮穿刺切割活检准确率的可能因素。方法回顾性分析300例有手术病理或临床及影像学随访结果、MSCT引导下经皮穿刺切割活检患者资料,将患者分为符合组和不符合组,对影响穿刺活检准确率的因素行统计学分析。结果 300例穿刺活检总准确率86.33%(259/300),术后并发症发生率6.67%(20/300)。两组病变大小、分布类型、病变内有无大量坏死或较大空洞、肺部病变周围是否合并阻塞性实变或不张)差异均有统计学意义(P均0.05),病变的良恶性对穿刺活检准确率的影响差异无统计学意义(P0.05)。结论影响MSCT引导下经皮穿刺切割活检准确率的可能因素有病变大小、分布类型、病变内有无大量坏死或较大空洞、肺部病变是否合并阻塞性实变或不张。     

Uncommon complication from left atrial appendage occluder (LAAO)

To decrease the risk of stroke due to atrial fibrillation, cardiologists will insert a device known as a left atrial appendage occluder to the left atrial appendage. This will decrease the stagnant flow of blood in that particular region. Known complications of this procedure include perforation, migration and dislodgement.We report a case with uncommon late complication of this device causing erosion of the left ventricle, in which open heart operation was carried out to repair the defect.     

实时三维经食管超声心动图定量评价心房颤动患者左心耳形态及功能

目的探讨实时三维经食管超声心动图(RT-3D-TEE)定量评估心房颤动(AF)患者左心耳(LAA)形态和功能的可行性。方法选取56例拟接受射频消融术的阵发性AF患者(阵发组)、26例持续性AF患者(持续组)及同期11名健康人(对照组),采用RT-3D-TEE测量3组LAA各参数。结果与对照组比较,阵发组LAA舒张末期容积(LAA-EDV)、收缩末期容积(LAA-ESV)、开口最大面积(A_(max))及最小面积(A_(min))均增大,射血分数(LAA-EF)、最大排空速度(Vep)、面积变化率(A%)及直径变化率(D%)均减小(P均0.05);持续组LAA-EDV、LAA-ESV、A_(max)、A_(min)增大,LAA-EF、Vep、A%、D%减小(P均0.05);阵发组与持续组间各参数差异均无统计学意义(P均0.05)。LAA-EF与ESV (r=-0.73,P0.01)、EDV(r=-0.64,P0.01)、A_(max)(r=-0.36,P0.01)及年龄(r=-0.27,P=0.02)呈负相关,与A%、D%、Vep呈正相关(r=0.86、0.74、0.55,P均0.01),与D_(max)无明显相关(P0.05)。结论 RT-3D-TEE能定量分析AF患者LAA形态及功能变化,对于评估AF患者病情具有一定临床意义。     

Concomitant left atrial appendage occlusion in patients undergoing cardiac surgery

The Left Atrial Appendage Occlusion Study (LAAOS III) was a multicenter, randomized controlled trial that included patients undergoing cardiac surgery who also had atrial fibrillation. The trial recruited 4811 participants, of which 2400 patients were randomized to undergo left atrial appendage (LAA) occlusion surgery, while 2411 participants had isolated cardiac surgery. The aim of the study was to determine whether concomitant occlusion of the LAA prevents ischemic stroke or systemic embolism. The study also evaluated the efficacy and safety of concomitant LAA occlusion in patients undergoing cardiac surgery. The number of ischemic strokes or systemic embolisms was significantly lower in the LAA occlusion group [114 (4.8%) vs. 68 (7.0%)] compared to the no-occlusion surgery group. There was also no increase in hospital length of stay or hospitalization for heart failure. It is expected that based on the findings of the LAAOS III study, the recommendations for concomitant LAA occlusion will be upgraded from the current class IIB to class I.     

Role of left atrial appendage occlusion in patients with HeartMate 3

Open in a separate window OBJECTIVESLeft atrial appendage occlusion (LAAO) at the time of implantation may reduce thromboembolic events (TEs) during continuous-flow left ventricular assist device support. The HeartMate 3 (HM3) reduces TEs overall, but the efficacy of LAAO in HM3 is unknown.METHODSAdults receiving first HM3 implantation from November 2014 through December 2019 at a single, large medical centre were retrospectively reviewed. TEs included device thrombosis and ischaemic stroke. Patients were classified by whether they received LAAO or not. Incidence of TEs was compared between groups using cumulative incidence curves with competing risks (death and heart transplant) and risk factors for TEs were assessed with Fine and Gray competing risk regression.RESULTSA total of 182 patients received HM3, of whom 99 (54%) received LAAO versus 83 (46%) who did not. There were 14 TEs, including 13 strokes (7%) and 1 pump thrombosis (0.5%). No significant difference in the incidence of TEs in each group was found (Gray’s test: P = 0.35). LAAO was not associated with TEs in multivariable Fine–Gray analysis (P = 0.10) and no significant risk factors for TEs were found. There were zero disabling strokes in those who received LAAO compared to 6 (7%) in those who did not receive LAAO (P = 0.008).CONCLUSIONSA low number of TEs was observed in HM3 recipients. LAAO did not further reduce the overall rate of TEs in this patient population, though its use may be beneficial in preventing disabling ischaemic strokes after HM3 implantation.     

Standalone epicardial left atrial appendage exclusion for thromboembolism prevention in atrial fibrillation

Open in a separate window OBJECTIVESMost strokes associated with atrial fibrillation (AF) result from left atrial appendage thrombi. Oral anticoagulation can reduce stroke risk but is limited by complication risk and non-compliance. Left atrial appendage exclusion (LAAE) is a new surgical option to reduce stroke risk in AF. The study objective was to evaluate the safety and feasibility of standalone thoracoscopic LAAE in high stroke risk AF patients.METHODSThis was a retrospective, multicentre study of high stroke risk AF patients who had oral anticoagulation contraindications and were not candidates for ablation nor other cardiac surgery. Standalone thoracoscopic LAAE was performed using 3 unilateral ports access and epicardial clip. Periprocedural adverse events, long-term observational clinical outcomes and stroke rate were evaluated.RESULTSProcedural success was 99.4% (174/175 patients). Pleural effusion occurred in 4 (2.3%) patients; other periprocedural complications were <1% each. One perioperative haemorrhagic stroke occurred (0.6%). No phrenic nerve palsy or cardiac tamponade occurred. Predicted annual ischaemic stroke rate of 4.8/100 patient-years (based on median CHA₂DS₂-VASc score of 4.0) was significantly higher than stroke risk observed in follow-up after LAAE. No ischaemic strokes occurred (median follow-up: 12.5 months), resulting in observed rate of 0 (95% CI 0–2.0)/100 patient-years (P < 0.001 versus predicted). Six all-cause (non-device-related) deaths occurred during follow-up.CONCLUSIONSStudy proved that a new surgical option, standalone thoracoscopic LAAE, is feasible and safe. With this method, long-term stroke rate may be reduced compared to predicted for high-risk AF population.     

对比盘式封堵器LAmbre与LAcbes封堵左心耳治疗心房颤动

目的 对比以盘式封堵器LAmbre与LAcbes行左心耳封堵(LAAC)治疗心房颤动(AF)的有效性和安全性。方法 分析99例接受以LAcbes封堵器(LAcbes组)、130例以LAmbre封堵器(LAmbre组)行LAAC的AF患者,对比治疗效果、安全性及预后。结果 LAcbes组左心耳完全封堵率66.67%(66/99),LAmbre组57.69%(75/130),组间差异无统计学意义(P>0.05)。LAcbes组密封盘直径、固定盘直径及封堵术后周边漏(特别是1~3 mm周边漏)发生率均低于LAmbre组(P均<0.01)。2组围术期均无急性心脏压塞及死亡病例。术后(中位复查时间为术后72天)复查经食管超声心动图,组间器械相关血栓发生率差异无统计学意义(P>0.05)。术后平均随访(12±6)个月,随访期间LAcbes组5例(5/99,5.05%)、LAmbre组1例(1/130,0.77%)发生延迟性心脏压塞,LAcbes组发生脑梗死、短暂性缺血发作各1例,LAmbre组发生脑梗死2例、脑出血1例、死于心力衰竭1例,2组差异均无统计学意义(P均>0.05)。结论 盘式封堵器LAmbre与LAcbes封堵左心耳治疗AF的效果及安全性均相当。