多层螺旋CT量化冠状动脉钙化的评价

目的 :探讨多层螺旋 CT（multi- slice spiral CT,MSCT）量化冠状动脉钙化的临床价值。方法 :对 4 1例临床可疑冠心病患者进行 MSCT冠脉成像及其钙化的量化分析 ,并与选择性冠状动脉造影 （CAG）进行对照。结果 :MSCT对冠状动脉钙化显示清晰 ;MSCT冠状动脉造影 （multi- slice spiral CT coronary angiography,MSCTCA）对冠状动脉各分支显示良好 ,其狭窄程度与冠脉造影一致。结论 :MSCT可作为冠心病普查和冠脉术后复查的较好方法。     

心脏移植术后冠状动脉病变的计算机断层扫描研究现状与方向

心脏移植已经成为终末期心力衰竭的最终有效治疗方式。但术后移植心脏血管病变严重影响患者长期存活。鉴于移植心脏去神经化导致的无症状或症状极不明显的特征,亟需一项有效、无创、适合国人的移植心脏血管病变诊断筛查工具。冠状动脉计算机断层扫描由于其较高的冠状动脉病变诊断价值成为一项比较令人满意的移植心脏血管病变诊断筛查工具,可以在国内尚未建立起冠状动脉造影或血管内超声筛查诊断移植心脏血管病变系统的情况下,发挥巨大的临床和预防作用,有利于患者自身利益和国内心脏移植的发展。     

Clinical application of lung CT in diagnosis and treatment for hospital-acquired pneumonia of cardiac surgery patients

Background Hospital-acquired pneumonia （HAP） is the most common and most serious nosocomial infection for cardiac surgery patients, with high incidence and fatality ratel. It is important for cardiac surgeons to correctly identify HAP, assess the severity, and then adjust anti-infection method, which can reduce the mortality rate, shorten hospitalization time, and reduce the waste of medical resources. The purpose of this research is to evaluate the application value of lung CT in diagnosis and treatment of HAP after cardiac surgery. Methods A retrospective analysis was conducted for clinical data about 76 cardiac surgery patients who were diagnosed with HAP during January to December 2013. The clinical data mainly included symptoms, physical signs, laboratory examinations （such as routine blood tests and serum procalcitonin）, and lung CT and X-ray data. Our focus is on the comparison between lung CT and X-ray data. Results The positive diagnostic rate, false negative rate, and false positive rate of lung CT were 71/76 （93.4%）, 5/76 （6.6%）, and 1/76 （1.3%） respectively. The coincidence rate of X-ray and CT was 45/76 （59.2%）, and the false negative rate of X-ray was 23/76 （30.3%）. Conclusion Lung CT is better than X-ray in diagnosis of HAP after cardiac surgery and assessment of severity, and has greater significance for guiding the rational useof antibiotics. Therefore, lung CT is worthy of application and popularization.     

Use of intraprocedural CT imaging to guide alcohol septal ablation of hypertrophic cardiomyopathy in the cardiac catheterization laboratory

Alcohol septal ablation (ASA) is a common treatment for hypertrophic cardiomyopathy. The success of the procedure is dependent on targeting a small dose of alcohol to the appropriate septal perforator in order to cause a myocardial infarction in the septum at the point of mitral valve contact. Typically, this is identified by injecting echocardiographic contrast into a septal vessel and using echocardiography to confirm that the area of septal–systolic anterior motion contact is highlighted. Rotational angiography using the C‐arm in the catheterization laboratory acquires a 3‐dimensional “CT‐like” image, and has shown promise in providing anatomic guidance in coronary and structural heart disease interventions. We demonstrate here a novel application of intraprocedural CT imaging to localize the region of interest for ASA in the catheterization laboratory. © 2012 Wiley Periodicals, Inc.     

The impact of CT image integration into an electroanatomic mapping system on clinical outcomes of catheter ablation of atrial fibrillation

Background: A detailed appreciation of left atrial/pulmonary vein (LA/PV) anatomy may be important in improving the safety and success of catheter ablation (CA) for atrial fibrillation (AF).
Objectives: The aim of this nonrandomized study was to determine the impact of computerized tomography (CT) image integration into a 3-dimensional (3D) mapping system on the clinical outcome of patients undergoing CA for AF.
Methods: Ninety-four patients (age: 56 ± 10 years) with AF (paroxysmal 46, persistent 48) underwent wide encirclement of ipsilateral PV pairs using irrigated radiofrequency ablation with the endpoint of electrical isolation. Ablation was guided by 3D mapping alone (electroanatomic 24, noncontact 23) in 47 (3DM group) patients and by CT image integration (Cartomerge®) in 47 (CT group). In persistent AF, a combination of linear ablation and targeted ablation of complex fractionated electrograms was also performed.
Results: Successful PV electrical isolation did not differ between the two groups. A significant reduction in fluoroscopy times was demonstrated in the CT group (49 ± 27 minutes vs 3DM group 62 ± 26 minutes, P = 0.03). Arrhythmia recurrence was reduced in the CT group (32% vs 51% in the 3DM group, P < 0.01). In 30 symptomatic patients (12 CT and 18 3DM), repeat procedures for AF (13 in 3DM and 5 CT, P ≤ 0.10) and AT (5 in 3DM and 7 CT, P = NS) were performed. Overall success on 7-day monitor off antiarrhythmic drugs was achieved in 60% in the 3DM group when compared with 83% in the CT group (P < 0.05) at a follow-up of 25 ± 5 weeks.
Conclusion: CA for AF guided by CT integration was associated with reduced fluoroscopy times, arrhythmia recurrence, and increased restoration of sinus rhythm. Improved visualization of complex LA geometries might improve the safety and success of CA for AF.     

The role of echocardiography and CT in the diagnosis of cardiac tumors

A young male who presented with atypical chest pain was found to have a primary cardiac tumor. Chest X-ray, electrocardiogram, and echocardiographic findings can be nonspecific. Differential diagnosis and the role of different diagnostic modalities including echocardiogram, computerized tomography and magnetic resonance imaging are discussed.     

Noninvasive flow evaluations of coronary artery bypass grafting using dynamic cardiac CT

We aimed to investigate the correlation of graft flow measurements between transit-time flow measurement (TTFM) during coronary artery bypass grafting (CABG) surgery and dynamic cardiac CT after the surgery.Fourteen patients underwent CABG with TTFM and postoperative dynamic cardiac CT; 11 internal thoracic artery (ITA) grafts and 15 saphenous venous grafts (SVGs) were included for analysis. Pearsons correlation analysis was performed for the comparisons of the TTFM and cardiac dynamic CT flow parameters.TTFM was not significantly correlated with the CT flow of the ITA grafts (r = −0.23, P = .49), but it had a very strong correlation with the CT flow of the SVGs (r = 0.83, P < .01).In patients who underwent CABG surgery, dynamic cardiac CT enabled quantitative evaluation of SVG flow, with good correlation with TTFM.