多层螺旋CT与超声心动图评估法洛四联症肺动脉发育的对比研究

目的探讨多层螺旋CT(MSCT)和经胸超声心动图(TTE)对法洛四联症(TOF)肺动脉发育评估的价值及对临床的指导意义。方法回顾性分析2016-2018年期间90例TOF手术患者,男性48例,女性42例,平均年龄(5.7±11.9)岁。采集术前MSCT和TTE影像资料,比对左、右肺动脉和腹主动脉内径,并计算McGoon指数;根据是否行I期根治术分为两组:姑息手术为A组,根治手术为B组,结合手术术中观察情况,进行肺动脉发育评价方法的比较。结果TTE对左、右肺动脉内径的测值及McGoon指数均小于MSCT,差异具有统计学意义(左肺动脉P=0.028,右肺动脉P=0.005,McGoon指数P=0.007);两者均有较好的重复性(ICC>0.75),其中MSCT更高,B组差异具有统计学意义(P=0.037);两种方法测量的左、右肺动脉内径、腹主动脉内径和McGoon指数均具有明显的相关性(r>0.8)。肺动脉发育较差的患者中,即A组各数据的相似度均大于B组,McGoon指数更明显。MSCT与TTE评估的McGoon指数在评估肺动脉发育及实施手术依据方面有很高的符合率(95.5%、94.4%),差异无统计学意义(P>0.05)。但两种方法在评价肺动脉发育较差患者时符合率均明显低于B组(MSCT P=0.029,TTE P=0.030)。结论MSCT与TTE均是对TOF肺动脉发育的有效检查技术,两者估测的McGoon指数均可以有效地指导临床。TTE评价TOF患者的肺动脉发育,因其重复性好、无创性等优点可用于姑息手术患者观察肺动脉发育情况的评价中。     

急诊床旁经胸超声心动图联合多层螺旋CT对主动脉夹层的诊断价值

目的探讨急诊床旁经胸超声心动图联合多层螺旋CT在主动脉夹层诊断中的应用价值。方法回顾性分析经手术确诊的46例主动脉夹层患者的病例资料,所有患者急诊床旁经胸超声心动图和多层螺旋CT检查。结果多层螺旋CT与急诊床旁经胸超声心动图联合应用阳性检出率与多层螺旋CT阳性检出率、急诊床旁经胸超声心动图阳性检出率之间差异有统计学意义(P<0.01),破口阳性检出率之间差异有统计学意义(P<0.01)。手术检出与两种方法联合检出无统计学意义(P>0.05)。结论急诊床旁经胸超声心动图联合多层螺旋CT能够及时、准确的对主动脉夹层做出诊断。     

CDFI诊断法洛四联症的临床价值

对23例法洛四联症(TOF)患者行彩色多普勒超声心动图(CDF I)检查结果与手术测量结果进行比较及分析。结果CDF I显示法洛四联症的四种畸形与临床手术诊断的符合率为100%。超声测量室间隔缺损直径、主动脉骑跨率及右室流出道内径与手术测量结果相关性良好(分别为r=0.674、0.681、0.669,P均<0.01)。认为CDF I可作为诊断TOF的主要手段,可为手术及判定疗效提供可靠依据。     

多层螺旋CT与经食管超声心动图检测心房颤动患者左心房血栓对比

目的 :探讨多层螺旋CT(MSCT)与经食管超声心动图(TEE)在检测心房颤动(房颤)患者左心房血栓的价值。方法:收集我院心内科2014年1月1日至2015年6月30日住院拟行房颤射频消融手术病例,在同一次住院期间均行MSCT与TEE检查,搜集2种检查方法检测血栓的结果,比较2种方法的敏感度和特异度。结果:MSCT与TEE诊断符合的为190例,其中6例2种方法均诊断为血栓,余184例均未发现血栓,诊断符合率为94.1%。MSCT检测血栓阳性或可疑阳性的8例患者,TEE则提示左心房及左心耳内淤血表现、云雾状影、絮状回声或未见明显血栓。另外4例TEE诊断为血栓者中1例为左心房前上壁附壁血栓、3例为左心耳少量血栓,而MSCT诊断未见血栓。以TEE为"金标准",MSCT检测血栓灵敏度60.0%,特异度95.8%,阳性预测值42.9%,阴性预测值97.9%,阳性似然比14.4,阴性似然比0.42。经过四格表配对χ~2检验,χ~2=45.936,P     

多层螺旋CT与超声心动图在主动脉根部形态中的应用

目的探讨多层螺旋CT(MSCT)与超声心动图在主动脉根部及邻近组织结构检测中的应用及其临床意义。方法 57例无明显主动脉瓣膜疾病、左室流出道病变患者行CT及超声心动图检查,并测量相关数据。结果 CT测量主动脉根部直径(23.40±3.03)mm,主动脉窦间距(33.65±3.87)mm,冠脉开口处直径(30.19±3.24)mm,升主动脉直径(31.23±4.19)mm。超声心动图测量主动脉根部内径(22.17±2.18)mm,升主动脉内径(29.73±3.68)mm,左室舒张末内径(43.23±3.19)mm,左室收缩末内径(29.19±2.97)mm。结论超声心动图与MSCT可良好显示主动脉根部组织结构、是否存在瓣膜病变,并可进行有效测量,为临床医师提供术前准备、术后随访影像学依据。MSCT与超声心动图检查在主动脉根部测量上存在差异。     

心房颤动导管消融术前多层螺旋CT对比食管超声检测心房血栓的应用价值探讨

目的对比食管超声（TEE）与多层螺旋CT（MSCT）在房颤导管消融术前左心房血栓筛选中的作用。方法顽固性房颤患者221例。导管消融术前常规TEE和／或MSCT检查除外心房血栓。比较TEE筛选（TEE组，45例）、MSCT筛选（MSCT组，141例）和两种方法均应用患者（T＋M组，35例）血栓的阳性检出率，并随访3组患者一过性脑缺血发作（TIA）和脑栓塞的发生率。结果TEE组5例发现左心耳血栓或自发声影（11．1％），MSCT组发现ll例（7．80％），T＋M组中1例MSCT检测发现左心耳血栓，而TEE未发现，另有2例TEE及MSCT均检测到左心耳血栓（8．57％）。201例患者接受肺静脉节段电隔离或环肺静脉电隔离治疗。在TEE组和MSCT组，各有1例手术过程中出现TIA（2．50％V80．78％）。MSCT组中，1例患者术后第2天发生脑栓塞（0．78％）。结论与TEE相比，MSCT对房颤导管消融术前患者心房血栓筛选的敏感度相近，提示MSCT也可以用来进行房颤患者导管消融术前心房血栓的筛选，并可能成为TEE重要的补充性检测方法。     

经胸超声心动图联合多层螺旋CT对肺高压患者的临床评估分析

目的 依据多层螺旋CT(Multislice spiral CT,MSCT)及经胸超声心动图(Transthoracic echocar-diography,TTE)分析肺高压患者的临床特征,探讨与疾病严重程度的相关性.方法 收集我院2018年8月至2021年1月经TTE评估为肺高压的83名患者的临床资料作为实验组,同...     

多层螺旋CT在法洛四联症解剖畸形及心功能评价中的应用价值探讨

目的探讨多层螺旋CT（MSCT）在法洛四联症（TOF）患者解剖及心功能改变评价中的应用价值。方法 32例经手术证实的TOF患者,术前均行MSCT和超声心动图（UCG）检查。以手术结果为标准,比较MSCT、UCG对TOF患者解剖畸形显示的正确率。比较MSCT、UCG测得的心室功能指标。结果 MSCT对TOF的诊断准确率为100%,对合并畸形的显示正确率为88.2%（30/34）,主要漏诊为心内畸形,MSCT测量的右室流出道（RVOT）、肺动脉干（MPA）、右肺动脉（RPA）起始处、左肺动脉（LPA）起始处、VSD的直径及骑跨率、左室射血分数（LVEF）与UCG测量结果差异无显著性,测得的左室舒张末期容积（LVEDV）大于UCG测量结果,但二者有显著的相关性。结论 MSCT是评价TOF患者解剖畸形及心室功能改变的良好无创性检查方法。     

多层螺旋CT诊断成人先天性冠状动脉畸形的临床价值

目的分析多层螺旋CT诊断成人先天性冠状动脉畸形(CCA)的临床价值。方法回顾性分析300名行多层螺旋CT冠状动脉成像(MSCTA)的资料,探讨冠状动脉的起源、走行和终止情况,统计成人先天冠状动脉畸形(CCA)的发生率及CT表现。结果300例中,检出各类CCA共84例,检出率为28.0%,其中起源异常11例,检出率3.7%;冠状动脉结构异常71例,心肌桥(MB)67例,检出率为22.3%,回旋支发育异常4例,检出率1.3%;冠状动脉终止异常2例,均为冠状动脉瘘,检出率0.7%。结论MSCT能够准确地显示冠脉起源、结构和终止异常,对成人冠状动脉畸形的诊断和预后判断有重要的临床应用价值。     

多层螺旋CT新技术

多层螺旋 CT(MSCT)是继滑环技术用于 CT使之产生螺旋 CT后的又一次重大技术性突破。 MSCT不但具有普通螺旋 CT的技术性能 ,而且在一些领域拓宽了其应用范围。1　 MSCT与普通螺旋 CT的不同点MSCT与单层螺旋 CT(SSCT)最大的不同点在于探测器结构和数据采集系统 (DAS)两方面的根本性改进 ,同时优化了重建算法 ,更新了螺距的概念。1.1　探测器的改进　 MSCT的最大改进就是将 SSCT的单排探测器 (90 0个左右 )改为几排或几十排的探测器 ,形成一个巨大的探测器阵列 ,根据不同的设计在 Z轴方向上可为 8～ 34排。现在具有生产 MSC…     

Prenatal diagnosis of tetralogy of Fallot associated with pulmonary artery sling: Two case reports

Tetralogy of Fallot (TOF) is a common condition accounting for 10%–20% of all fetal cyanotic congenital heart disease cases. Pulmonary artery sling (PAS), or aberrant left pulmonary artery, is a rare congenital cardiovascular malformation. Approximately 58%–83% of PAS is associated with other cardiovascular malformations, TOF being rarest. The diagnosis of PAS is generally incidental or made at autopsy. Cases of prenatal diagnoses of TOF associated with PAS have not yet been reported. Here, we report two cases of TOF associated with PAS diagnosed prenatally in our hospital.     

Echocardiographic assessment of adults with tetralogy of Fallot

Advances in medical and surgical management of congenital heart disease in the last three decades have resulted in a great many survivors to adulthood. Proper care requires intimate knowledge of the basic malformations and their surgical anatomy and results. Tetralogy of Fallot, the most common cyanotic malformation in adults, represents a spectrum from mild right ventricular outflow tract obstruction to complete pulmonary atresia. Evaluation of surgical residua and sequelae includes imaging of aortic-to-pulmonary arterial palliative shunts, detection of residual ventricular septal defect patch leaks or right ventricular outflow tract obstruction, definition of extracardiac conduit patency, and quantitation of ventricular function and valvular regurgitation. Refined echocardiographic imaging and hemodynamic definition is a mainstay in precise segmental anatomical and hemodynamic assessment. Transesophageal echocardiography is particularly important for intraoperative evaluation of surgical results.     

Use of cutting balloon for palliative treatment in tetralogy of Fallot.

In tetralogy of Fallot, severe cyanosis due to insufficient pulmonary blood flow necessitates early intervention. The Cutting Balloon, developed for percutaneous coronary angioplasty, was used successfully for transcatheter incision and dilation of infundibular and valvar pulmonary stenosis in four patients with tetralogy of Fallot.     

Late surgical treatment of tetralogy of Fallot

Aim

To study early post-operative results and follow up of patients over a year old, operated on for tetralogy of Fallot (ToF).

Methods

This retrospective analysis included 22 patients (14 male and eight female) with a mean age of 9.18 ± 6.5 years (range 13.5 months to 26 years), who underwent complete repair of ToF between April 2003 and June 2009. Data from patients’ records, pre-operative cardiac catheterisation studies, operative intervention, and pre-operative and postoperative two-dimensional echocardiographic studies were reviewed. All patients underwent complete repair including closure of ventricular septal defect (VSD). A trans-annular patch was used in 12 patients while an infundibular patch was used in 10 others. Patients were evaluated one, three, six and 12 months after surgery, and annually thereafter. The duration of follow up was from eight months to six years post surgery.

Results

Classical ToF was found in 10 patients. Twelve cases had associated anomalies: two patients with hypoplastic pulmonary artery branches, two with arterial duct malformations, and eight had proximal stenosis of the left branch of the pulmonary artery. NHYA class distribution was as follows: class I: two patients; class II: five subjects; class III: 10 patients; class IV: five subjects. The mean stay in hospital was 15 ± 7 days. Two patients (9%) died during the early post-surgical period. At a mean follow-up interval of 32 ± 9 months, all patients were asymptomatic and in NYHA class I. No late deaths occurred. In three patients, we registered isolated monomorphic ventricular extrasystoles. The right ventricle outflow tract (RVOT) pressure gradient was 29 ± 1.5 mmHg in the acute post-surgical period and it did not change significantly during follow up. The right ventricular function was defined as normal in 95% of the patients in the study and was mildly depressed in 5%.

Conclusion

Even if treated later in life, our study showed very good surgical results of patients with ToF.     

Myopathy,Left Ventricular Noncompaction,and Tetralogy of Fallot

Left ventricular hypertrabeculation, also termed noncompaction (LVHT) is a cardiac abnormality characterized by excessive trabeculations of the left ventricular cavity. LVHT may be associated with extracardiac abnormalities, most frequently neuromuscular disorders (NMDs). LVHT associated with tetralogy of Fallot (ToF), so far, has been reported in 2 cases, but no indication for the presence of NMDs are given. We present a 47‐year old female who underwent 2 cardiac surgeries because of ToF, and was admitted because of heart failure. She was diagnosed with echocardiographic LVHT. A myopathy was diagnosed by biopsy. Copyright © 2009 Wiley Periodicals, Inc.     

Coronary artery anomalies in tetralogy of Fallot patients evaluated by multi slice computed tomography; myocardial bridge is not a rare finding

Based on coronary angiography and interoperative inspection, anomalous origin of coronary artery crossing the right ventricular outflow tract (RVOT) is common in tetralogy of Fallot (TOF) patients. However, other coronary anomalies may be underestimated due to the overlying myocardium, epicardial fat, or adhesions due to previous palliative surgery. Currently, coronary artery visibility dramatically improved by multislice computed tomography (MSCT). We performed this study to assess the coronary arteries anatomy in TOF patients using MSCT.All TOF patients underwent MSCT examination at our centre from 2013 till 2019 were included. Assessment of the coronary arteries’ origin and course were performed. Presence of myocardial bridge were assessed, and indexed RV mass was calculated.318 TOF patients were included, median age 2 years (range 1 month–46 years), 175 males (55%). The abnormal coronary artery origin and course were detected in 20 patients (6%); coronary artery crossed RVOT in 13 patients (65%), 5 patients (25%) had a retro-aortic course and 2 patient (10%) had inter-arterial course. Myocardial bridges of left anterior descending artery or/and right coronary artery were reported in 100 patients (36%), no myocardial bridge of left circumflex was reported. RV mass was 29.0 ± 21.1 g/m². There was no correlation between RV mass and presence of myocardial bridges.MSCT is a useful imaging modality for detection of coronary arteries anomalies in TOF patients. Coronary artery crossing RVOT is not the only abnormal course and myocardial bridging is not a rare finding. Further studies are needed to demonstrate the clinical significance of these observations.     

Coronary artery disease in adults with tetralogy of Fallot

Background: There are limited data about outcomes of coronary artery disease (CAD) in adults with repaired tetralogy of Fallot (TOF). The purpose of this study was to describe the prevalence and treatment of CAD in adults with TOF, and the impact of CAD on long‐term survival.
Methods: Retrospective review of MACHD database for adults with repaired TOF who underwent aortic root/selective coronary angiogram, 1990‐2017. Patients were categorized into three groups: (1) No CAD defined as normal coronary angiogram; (2) Mild CAD defined as ≤50% stenosis in all vessels; and, (3) Significant CAD defined as >50% stenosis in any vessel.
Results: We identified 105 (23%) of 465 TOF patients that had angiograms; mean age 47 ± 12 years. The prevalence of mild CAD and significant CAD was 19% (20 pa‐ tients) and 15% (16 patients), respectively. Of these 16 patient with significant CAD, 9 (56%), 3 (19%), and 4 (24%) patients received guideline directed medical therapy, percutaneous coronary intervention, and coronary artery bypass grafting, respec‐ tively. Significant CAD was an independent risk factor for mortality (HR: 2.03, 95% CI 1.64‐4.22, P = .022) after adjustment for differences in age, and prevalence of atrial fibrillation and renal dysfunction.
Conclusions: Based on a review of a selected cohort of 105 TOF patients, the preva‐ lence of mild CAD and significant CAD was 19% and 15%, respectively. Significant CAD was an independent risk factor for mortality. There is need for more research to determine optimal noninvasive diagnostic strategies and optimal patient selections and methods for revascularization.