不同分型的二叶式主动脉瓣畸形与主及肺动脉扩张关系的超声探究

目的应用超声心动图研究不同分型二叶式主动脉瓣畸形(BAV)与主、肺动脉扩张的关系。方法回顾性分析我院经胸超声心动图诊断的382例BAV患者,按照Sievers′分型进行分组。另选取正常对照组200例。分别测量主动脉瓣瓣环、窦部、窦管结合部、升主动脉近端及主肺动脉近段内径。结果 382例BAV患者中,0型44例,1型338例,其中1(L-R)型226例、1(R-N)型97例、1(N-L)型15例。0型瓣环、窦管结合部、升主动脉及主肺动脉近段内径均较对照组增宽(P0.05),窦管结合部和升主动脉内径增宽显著(P0.01)。1型瓣环、窦部、窦管结合部、升主动脉及主肺动脉近段内径较对照组明显增宽(P0.01)。1型瓣环、窦部、窦管结合部内径较0型增宽(P0.05),窦部内径增宽明显(P0.01)。1(L-R)型较1(R-N)型窦部内径显著增宽(P0.01),1(N-L)型与其他两型窦部内径相比无差异(P0.05)。三型之间瓣环、窦管结合部、升主动脉及主肺动脉内径相比无差异(P0.05)。结论 BAV患者常伴有主动脉及肺动脉内径增宽。1型比0型BAV主动脉根部内径增宽。1(L-R)型在主动脉根部扩张显著。     

基于超声心动图观察儿童单纯二叶式主动脉瓣

目的 基于超声心动图观察儿童单纯二叶式主动脉瓣(i-BAV)表现。方法 回顾性分析79例i-BAV患儿超声心动图,观察其i-BAV分型;根据有无瓣膜和/或主动脉受累分为并发症组(n=50)与无并发症组(n=29),比较组间超声心动图参数。结果 经体表面积(BSA)校正后,并发症组左心室收缩末期内径/BSA低于、而左心室心肌质量指数高于无并发症组(P均＜0.05)。79例中,Type 0型22例、以lat亚型最多见(18/22,81.82%),Type Ⅰ型57例、以L-R亚型最多见(39/57,68.42%)。并发症组以Type Ⅰ L-R亚型最多见(31/50,62.00%);瓣膜受累发生率为90.00%(45/50),以轻度主动脉瓣狭窄和/或关闭不全为主(37/45,82.22%);主动脉受累发生率为24.00%(12/50),均表现为Ⅰ、Ⅱ型主动脉增宽。结论 儿童i-BAV最常见分型为Type Ⅰ L-R亚型,以轻度瓣膜损害为主要并发症,可存在左心室心肌重构。     

经胸超声心动图诊断二叶式主动脉瓣畸形及合并症的临床价值

目的探讨经胸超声心动图诊断二叶式主动脉瓣畸形(BAV)及其并发症的临床意义。方法回顾性分析我院经胸超声心动图诊断的BAV患者43例,超声分析其分型、瓣膜病、主动脉扩张及心内畸形等并发症,并与经食管超声心动图及手术结果进行比较分析。结果 43例经胸超声心动图初诊BAV患者,经手术(17例)或经食管超声(24例)确诊41例,2例误诊,经胸超声心动图诊断准确率95.3%。其中左、右冠瓣融合(L-R)型29例(70.7%),右、无冠瓣融合(R-N)型10例(24.4%),左、无冠瓣融合(L-N)型2例。主动脉扩张16例(39.0%)。单纯BAV不伴狭窄、关闭不全4例(9.7%);主动脉瓣轻度狭窄16例(39.0%),轻度关闭不全4例(9.7%);17例进行手术的患者中,中至重度狭窄伴关闭不全10例,其中轻度狭窄伴重度关闭不全及赘生物形成2例,主动脉瓣中重度关闭不全5例。其他心内畸形4例。L-R型发生瓣膜病、主动脉扩张比率最高;手术患者发生中重度并发症者及发病年龄均显著高于未手术者,差异均有统计学意义(均P0.05)。结论经胸超声心动图能提供BAV的超声分型,明确合并瓣膜病、主动脉扩张及其他心内畸形情况,为手术适应证选择及治疗提供全面准确的信息,是BAV及其并发症确诊及随访的首选检测手段。     

超声诊断二叶主动脉瓣合并感染性心内膜炎

目的 观察经胸超声心动图（TTE）和三维经食管超声心动图（3D-TEE）诊断二叶主动脉瓣（BAV）合并感染性心内膜炎（IE）的价值。方法 回顾性分析53例BAV合并IE患者的超声图像，超声表现包括赘生物、瓣膜穿孔、脓肿和瘘道。以外科手术所见作为金标准，评估TTE和3D-TEE的超声特征及其诊断价值。结果 3D-TEE检出赘生物、瓣膜穿孔、脓肿和瘘道的敏感度（100% vs.90.20%，96.87% vs.90.62%，92.86% vs.67.86%，94.12% vs.70.59%）和阳性预测值均高于TTE（100% vs.95.83%，100% vs.93.55%，96.30% vs.86.36%，100% vs.85.71%，P均<0.05）。结论 超声心动图对于BAV合并IE的总体检出率高。3D-TEE的可视性和空间分辨率比TTE更好，诊断BAV合并IE敏感度和阳性预测值更高。     

经食管超声心动图在牛心包主动脉瓣置换术中的应用

目的 评价术中经食管超声心动图（IOTEE）在牛心包主动脉瓣置换术中的应用价值。方法 回顾性分析拟施行牛心包主动脉瓣置换术的106例患者,分别于体外循环前采用IOTEE测量和术中解剖测量主动脉瓣环径、主动脉窦部和主动脉窦管交界直径、主动脉瓣叶有效高度（eH）。结果 术前拟行牛心包主动脉瓣置换术106例患者,其中8例经IOTEE术前补充诊断后修改手术方式被排除。余98例均接受牛心包主动脉瓣置换术。98例IOTEE首要诊断与手术诊断符合率为100%,5例（5/98,5.10%）IOTEE次要诊断与手术诊断不相符。98例患者体外循环前IOTEE提示瓣叶数目与术中探查符合率100%、瓣叶穿孔符合率80.00%,瓣叶赘生物符合率85.71%、老年退行性钙化符合率100%、风湿性病变符合率100%。体外循环前IOTEE测量的主动脉瓣环径、主动脉窦部和主动脉窦管交界直径、eH与术中实际测量结果相关性良好（r均>0.8,P均<0.05）。结论 IOTEE对于评估牛心包主动脉瓣置换术的可行性、指导选择手术方案和预估手术效果有重要意义。     

经胸超声心动图诊断A型主动脉壁间血肿

目的 观察经胸超声心动图诊断A型主动脉壁间血肿的价值。方法 回顾性分析40例经CT血管成像（CTA）确诊的A型主动脉壁间血肿患者的临床资料及超声心动图表现,评价经胸超声心动图诊断A型主动脉壁间血肿的价值。结果 40例A型主动脉壁间血肿患者,男25例（25/40,62.50%）,女15例,发病中位年龄55岁;以胸背部疼痛（36/40,90.00%）为主要症状;其中30例有高血压病史、15例有吸烟史。主动脉壁间血肿超声主要表现为主动脉壁内-中膜与外膜间存在厚薄不均匀低回声;主动脉窦部增宽与年龄、高血压病史相关（r=0.51,P=0.01;r=0.34,P=0.03）。25例（25/40,62.50%）合并主动脉瓣反流,其中21例（21/25,84.00%）为轻度反流;12例合并心包积液,其中10例（10/12,83.33%）为少量积液。结论 经胸超声心动图对诊断A型主动脉壁间血肿有一定价值,并可用于患者随访。     

经食管超声心动图双平面法测量主动脉瓣环径

目的 探讨经食管超声心动图双平面法测量经导管主动脉瓣植入术（TAVI）患者主动脉瓣环径的可行性。方法 对24例拟行TAVI的患者,术前分别采用经胸超声心动图（2D-TTE）、经食管超声心动图（2D-TEE）、三维经食管超声心动图（3D-TEE）及经食管超声心动图双平面法（Bip-TEE）测量主动脉瓣环径。比较4种方法测量的差异以及3D-TEE测量值与另外3种方法测量值的相关性。结果 2D-TTE、2D-TEE、Bip-TEE与3D-TEE所测的主动脉瓣环径分别为（22.02±2.21）mm、（23.34±2.34）mm、（23.89±2.37）mm;（24.21±2.78）mm,4组测量值总体差异有统计学意义（F=3.88,P=0.01）。3D-TEE与2D-TEE、Bip-TEE所测量主动脉瓣环径差异无统计学意义（P均>0.05）,2D-TEE与Bip-TEE测量值差异无统计学意义（P>0.05）。2D-TTE与3D-TEE、2D-TEE、Bip-TEE所测的主动脉瓣环径比较差异均有统计学意义（P均<0.05）。3D-TEE所测的主动脉瓣环径与2D-TTE、2D-TEE、Bip-TEE测值均呈正相关（r=0.79、0.88、0.94,P均<0.05）。结论 经食管超声心动图双平面法可用于准确测量主动脉瓣环径,从而为TAVI提供可靠的瓣膜型号选择依据。     

术前评估成人房间隔缺损合并器质性二尖瓣关闭不全

目的 探讨成人房间隔缺损（ASD）合并器质性二尖瓣关闭不全（MR）的特异性超声心动图表现。方法 收集372例接受ASD心内修复术的成人患者,根据是否同时或分期行二尖瓣成形术或置换术分为两组,即病例组（n=45）和对照组（n=327）。应用多因素回归法筛选ASD合并器质性MR的术前危险因素。结果 病例组患者左心室舒张末期内径（LVEDD）、左心房内径（LAD）、肺动脉内径（PAD）和二尖瓣瓣环内径明显大于对照组（P均<0.05）;二尖瓣和三尖瓣的舒张早期峰速（Em、Et）均明显高于对照组（P均<0.05）;二尖瓣环和三尖瓣环侧壁处的舒张晚期峰速（Am''、At''）、三尖瓣侧壁瓣环处收缩期运动峰速（St''）明显小于对照组（P均<0.05）;肺动脉收缩压（PASP）明显高于对照组（P=0.004）,三尖瓣反流程度也明显大于对照组（P=0.002）。其中二尖瓣瓣环扩张、LVEDD增大、St''偏低和PAD明显扩张,是成人ASD合并器质性MR的独立危险因素。结论 二尖瓣瓣环内径明显扩大和LVEDD增大是ASD患者左心室前负荷增加的特异性超声心动图表现。     

单中心143例儿童主动脉瓣二叶畸形的超声心动图分析

目的 分析儿童主动脉瓣二叶畸形（BAV）的超声心动图特征。方法 回顾性分析我院143例BAV患儿的临床及超声心动图资料,按照Sievers等提出的BAV分类方法对儿童BAV进行分型,总结儿童BAV的超声心动图特征、并发症等。结果 143例BAV患儿以Type1,R-L型最多见（74例）,其次为Type0,lat型（32例）。BAV合并其他先天性心血管畸形64例,以主动脉弓部异常及其复合畸形最多见（21例）;单纯BAV 79例,其中50例出现并发症（40例为Type1型）,包括瓣膜损害38例（主动脉瓣狭窄18例）,主要表现为轻度狭窄,主动脉脉受累12例。单纯BAV患儿中,有并发症者与无有并发症者的左室射血分数比较差异无统计学意义,但是前者左室心肌质量指数增加（58.6±15.4 vs. 51.3±13.0）,二者比较差异有统计学意义（P＜0.05）。结论 儿童BAV最常见的分型为Type1,R-L型,常合并其他先天性心血管畸形,以主动脉弓部异常及其复合畸形最为常见。单纯BAV在儿童期就可以出现瓣膜功能损害及主动脉扩张等并发症,导致其左室心肌已经发生重构。     

超声心动图诊断先天性单叶主动脉瓣

目的 探讨超声心动图诊断先天性单叶主动脉瓣的价值。方法 回顾性分析20例在我院接受超声心动图检查并诊断为单叶主动脉瓣的患者资料。结果 20例均出现不同程度主动脉瓣瓣膜功能障碍,其中6例（6/20,30.00%）表现为单纯主动脉瓣狭窄,3例（3/20,15.00%）表现为单纯主动脉瓣反流。2例（2/20,10.00%）为无交界型,舒张期未见关闭线;18例（18/20,90.00%）为交界型,闭合线呈逗点样,附着点多位于1~7点钟位置。17例升主动脉狭窄后扩张。9例伴其他心内畸形,4例有并发症。结论 超声心动图可早期诊断先天性单叶主动脉瓣畸形,实时动态显示单叶瓣的几何形态、启闭情况,定量评价其狭窄及反流程度,为选择治疗方式及评估预后提供依据。     

Aortic dilatation and calcification in asymptomatic patients with bicuspid aortic valve: analysis in a Korean health screening population

Entire anatomic area involved in the bicuspid aortic valve (BAV) disease has not been studied well, especially in Asian populations. We investigated prevalence and vascular characteristics of the BAV disease in a Korean population. In a health screening program from 2005 through 2010, 38 BAV patients (BAV group, 0.16 %, 35 males) were isolated among a total of 23,291 persons based on echocardiography. Each BAV patient was matched with three TAV patients (TAV group, n = 114) of the same age, gender, BSA, and hypertension. Using echocardiography and low-dose chest CT scan, diameters of the aortic root to proximal descending aorta (pDA) and pulmonary artery (PA), morphologic types of BAV, and calcification in the aortic root were evaluated in both groups. Diameters of the sinotubular junction and ascending aorta in BAV group were larger than in TAV group (29 ± 7 vs. 27 ± 3 mm, p = 0.046; 42 ± 7 vs. 34 ± 4 mm, p < 0.001, respectively). Diameters of the annulus, sinus of Valsalva, aortic arch, pDA, and PA were not different between two groups. Calcification in the aortic root was approximately seven times more common in BAV group (p < 0.001). Diameters of the aortic root were larger in the R-L type (n = 24) than in the R-N type (n = 11). Prevalence of BAV in a Korean population appears lower than in Western populations. Within the entire anatomic boundaries of BAV, the ascending aorta was predominantly dilated in BAV patients. The R-L type showed more dilatation than the R-N type, not in the ascending aorta but in the aortic root.     

Measurement of the ascending aorta diameter in patients with severe bicuspid and tricuspid aortic valve stenosis using dual-source computed tomography coronary angiography

We aimed to evaluate the diagnostic performance of dual-source computed tomography coronary angiography (DSCT-CA) in the measurement of the ascending aorta (AA) diameter and compare the AA diameter in patients with severe bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) stenosis. Eighty-eight consecutive patients (50 men, mean age 60.3 ± 13 year) with severe aortic stenosis (AS) underwent DSCT-CA before aortic valve surgery. Seventy-four of the 88 patients underwent cardiovascular magnetic resonance (CMR). The internal diameter of AA was measured from early-systole with DSCT-CA and CMR by 2 radiologists independently at 4 levels (aortic annulus, sinuses of Valsalva, sinotubular junction, and tubular portion at the right pulmonary artery). The patients were divided in to 2 groups (BAV [n = 53]; TAV [n = 35]) according to operative findings. Patients with BAV were significantly younger than those with TAV (P = 0.0035). Inter-observer agreement of AA diameters at 4 levels with DSCT-CA and CMR was excellent (intraclass correlation coefficient = 0.89-0.97). Also, the DSCT-CA and CMR measurements of the AA diameter strongly correlated (r = 0.871-0.976). Mean diameter of the AA by DSCT-CA was significantly larger in patients with BAV (34.4 ± 8.2 mm) as compared to those with TAV (30.6 ± 5.5 mm). The diameters at the sinuses of Valsalva, sinotubular junction, and tubular portion were significantly larger in BAV than in TAV. Twenty-two of 53 (41.5%) patients with BAV and 2 of 35 (5.7%) patients with TAV had AA dilatation > 45 mm. DSCT-CA allows accurate assessment of the AA diameters in patients with severe AS. Patients with severe BAV stenosis had larger AA diameters and higher prevalence of AA dilatation > 45 mm as compared to those with severe TAV stenosis.     

Sex Differences in Children and Young Adults With Bicuspid Aortic Valve Disease in First Two Decades of Life

ObjectiveTo elucidate sex differences in valve morphology, disease phenotype, progression, and outcomes among children and young adults with bicuspid aortic valve (BAV).Patients and MethodsThis is a retrospective cohort study examining all children and young adults (aged ≤22 years) with isolated BAV diagnosed, by excluding patients with concomitant congenital heart defects or genetic syndromes, from January 1, 1990, through December 1, 2016, at Mayo Clinic in Rochester, Minnesota.ResultsOf 1010 patients with BAV, 558 had isolated BAV. Distributions of morphology were right-left in 65.8% (n=367), right-noncoronary in 34% (n=190), and left-noncoronary cusp fusion in 0.2% (n=1) of patients; with no sex differences. Male to female ratio was 3:1. At the first echocardiographic evaluation in the study, there were no sex differences in terms of frequency of aortic valve stenosis or regurgitation. However, males had significantly higher grades of aortic valve regurgitation at 17 years of age onward (P<.0001). Males had significantly larger mid-ascending aorta (P=.01) and sinus of Valsalva dimensions (z score; P=.0001) as compared with females, with a novel finding of peak aortic dimensions around 8 years of age. Males also had more than 2-fold higher risk for sinus of Valsalva dilation (z score >2) as compared with females (odds ratio, 2.3; 95% CI, 1.2 to 4.2; P=.01). There were no significant sex differences in the primary cardiac outcomes of interventions on aortic valve and/or aorta, aortic dissection, or death.ConclusionIn children and young adults with BAV, males have a higher grade of aortic regurgitation in late adolescence, significantly larger aortic dimensions, different patterns of aortic growth, and more frequent sinus of Valsalva dilation as compared with females. Overall, the rate of primary cardiac events is lower in young patients, with no significant sex differences.     

超声诊断主动脉窦瘤

本文报告31例主动脉窦瘤患者,全部用二维超声(2DE)和多普勒超声检查。其中手术治疗24例,超声符合22例,符合率为92％。误诊2例,误诊率为8％。故超声实际诊断主动脉窦瘤29例中右冠窦瘤18例(62％),无冠窦瘤7例(24％),二叶瓣型主动脉窦瘤4例(14％)。窦瘤破入/膨入右室和右房内的例数分别为16例和13例。本病主要的合并症为主动脉瓣关闭不全和室缺。通过分析我们认为二维加多普勒超声是诊断主动脉窦瘤最有价值的无创技术。     

二叶式主动脉瓣主动脉病变相关基因突变者的影像学特征与遗传学分析

目的探讨主动脉病变相关基因与二叶式主动脉瓣(BAV)相关性主动脉病变的关系。方法选取行Bentall手术并检测到主动脉病变相关基因突变的8例BAV患者,应用超声心动图评估其BAV分型、瓣膜功能及升主动脉内径等指标;收集其外周血并对主动脉疾病相关基因进行筛查,对变异进行致病性预测;记录患者一般临床参数及实验室检查结果。结果 8例患者中5例主动脉最宽处位于升主动脉管部,3例位于主动脉窦部。2例以主动脉瓣狭窄表现为主,5例以主动脉瓣关闭不全表现为主,1例主动脉瓣狭窄与关闭不全程度相当。4例患者FBN1基因突变(分别为c.2926C>Tp.Arg976Cys、c.2374T>Cp.Cys792Arg、c.2639G>Ap.Gly880Asp、c.6700G>Ap.Val2234Met),2例COL3A1基因突变(分别为c.2190A>Tp.GLU730Asp、c.2181G>Ap.Met727Ile),1例MYLK基因突变(c.1414C>Tp.Leu472Phe),1例TGFBR1基因突变(c.134A>Gp.Asn45Ser)。8例患者中1例FBN1基因突变患者为Sievers0型BAV,余7例均为SieversⅠ型BAV,其中RL亚型6例,RN亚型1例。3例FBN1基因突变患者(c.2926C>Tp.Arg976Cys,c.2374T>Cp.Cys792Arg,c.2639G>Ap.Gly880Asp)经3个突变评价软件预测均为可能致病性突变,该3例患者胸主动脉最大径显著高于其他患者。结论基因变异相关的解剖结构异常及主动脉瓣功能改变所引起的血流动力学变化可能共同导致了BAV患者不同类型的主动脉病变。     

Imaging of an aneurysm of the sinus of Valsalva with transesophageal echocardiography, contrast angiography and MRI

A sinus of Valsalva aneurysm is an uncommon congenital defect, which requires appropriate diagnosis with either echocardiography, magnetic resonance imaging or contrast angiography. Treatment consists of aortic valve repair. We describe a young woman with an aneurysm of the non-coronary sinus of Valsalva, an atrial septal defect and pulmonary insufficiency. The different imaging techniques and possibilities of surgical correction are described.     

实时三维超声心动图诊断二叶主动脉瓣畸形

目的 探讨实时三维超声心动图(RT-3DE)评价二叶主动脉瓣(BAV)畸形的应用价值。 方法 应用经胸二维超声心动图(2DE)和RT-3DE对41例BAV患者进行诊断,并与手术结果对照。 结果 经RT-3DE检查的41例患者与手术结果一致,其中横裂式25例、纵裂式10例、斜裂式6例;经2DE检查的30例患者与手术结果一致。2例患者2DE观察不清晰的赘生物,RT-3DE显示为附着于主动脉瓣叶心室面的赘生物。 结论 RT-3DE能够快速、直观、准确显示瓣膜结构,在BAV的诊断中可获得较2DE更丰富的空间信息,具有重要应用价值。     

Comprehensive 4-stage categorization of bicuspid aortic valve leaflet morphology by cardiac MRI in 386 patients

Bicuspid aortic valve (BAV) disease is heterogeneous and related to valve dysfunction and aortopathy. Appropriate follow up and surveillance of patients with BAV may depend on correct phenotypic categorization. There are multiple classification schemes, however a need exists to comprehensively capture commissure fusion, leaflet asymmetry, and valve orifice orientation. Our aim was to develop a BAV classification scheme for use at MRI to ascertain the frequency of different phenotypes and the consistency of BAV classification. The BAV classification scheme builds on the Sievers surgical BAV classification, adding valve orifice orientation, partial leaflet fusion and leaflet asymmetry. A single observer successfully applied this classification to 386 of 398 Cardiac MRI studies. Repeatability of categorization was ascertained with intraobserver and interobserver kappa scores. Sensitivity and specificity of MRI findings was determined from operative reports, where available. Fusion of the right and left leaflets accounted for over half of all cases. Partial leaflet fusion was seen in 46% of patients. Good interobserver agreement was seen for orientation of the valve opening (κ?=?0.90), type (κ?=?0.72) and presence of partial fusion (κ?=?0.83, p?<?0.0001). Retrospective review of operative notes showed sensitivity and specificity for orientation (90, 93%) and for Sievers type (73, 87%). The proposed BAV classification schema was assessed by MRI for its reliability to classify valve morphology in addition to illustrating the wide heterogeneity of leaflet size, orifice orientation, and commissural fusion. The classification may be helpful in further understanding the relationship between valve morphology, flow derangement and aortopathy.     

Characteristics of aorto-iliofemoral arterial tree according to aortic valve morphology in chinese patients considered for TAVR

To characterize the anatomy of aorto-iliofemoral arterial tree according to aortic valve phenotype by CT in patients referred for transcatheter aortic valve replacement (TAVR). We retrospectively enrolled 215 patients screened for TAVR who underwent CT. Dimensions, calcification, vascular tortuosity index score and other putative risk features of 13 different regions were evaluated for bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) morphology. The study consisted of 44% BAVs with younger age than TAVs. The dimensions of the annulus, sinus of Valsalva, ascending aorta and aortic arch were consistently larger in BAVs. The prevalence of calcification of aortic arch was significantly higher in TAVs even after adjustment for atherosclerotic risk factors. BAVs was associated with two-fold higher odds of having over I degree AA calcification (odds ratio 2.02; 95% CI 1.60–5.31; p?<?0.001). The prevalence of severe iliac tortuosity was higher among BAVs (11.7 vs. 2.5%, p?=?0.015). BAVs had a trend to more atheroma than TAVs in the abdominal aortic artery and iliofemoral artery. BAV anatomy is common in Chinese AS patients screened for TAVR. Aorto-iliofemoral pathology varies according to aortic valve phenotype, which may contribute to technical challenges in BAV vs. TAV anatomy and support the need for the integrated risk assessment for each valve phenotype.     

双源CT血管造影综合评估StanfordA型主动脉夹层

目的 评价双源CT血管造影(DSCTA)综合评价Stanford A型主动脉夹层(AD)主动脉根部结构﹑冠状动脉和左心室功能的可行性。方法 对36例Stanford A型AD患者行术前心电门控DSCTA扫描,评价冠状动脉、主动脉及主动脉瓣膜图像质量及受累情况,测量主动脉根部管径和左心室功能,计算辐射剂量。将DSCTA结果与手术所见进行比较。结果 35例患者成功完成DSCTA检查。97.14%(34/35)的胸主动脉和主动脉瓣膜图像、93.10%(445/478)的冠状动脉节段图像可用于诊断。右窦受累17例,无窦受累15例,左窦受累5例;右-无窦交界受累13例,左-右窦交界受累3例,左-无窦交界受累1例。主动脉窦部直径(41.6±9.4)mm;瓣环直径(28.2±4.1)mm;窦管交界直径(73.6±10.2)mm。左心室射血分数与主动脉根部受累程度呈负相关(r=-0.97,P=0.02)。平均有效辐射剂量为(21.96±4.36)mSv。DSCTA结果与手术病理诊断一致率(30/34,88.24%)和一致性(Kappa=0.82,P<0.01)均较高。结论 DSCTA"一站式"检查综合评价Stanford A型AD主动脉根部结构﹑冠状动脉和左心功能安全可靠。