多排螺旋CT检测肺静脉变异及肺静脉孔指数在心房颤动射频消融术前的应用

目的评价心房颤动（房颤）射频消融术前肺静脉变异类型及肺静脉孔指数。方法回顾性分析2005年6月至2006年5月房颤患者射频消融术前16排螺旋CT肺静脉造影64例,在最大密度投影重建图像上测量左上、左下、右上、右下、共干及独立肺静脉孔处肺静脉的前后径及上下径,计算肺静脉孔指数,比较左上、左下、右上、右下肺静脉孔指数差异有无统计学意义。所有统计工作由SPSS软件完成。结果在64例房颤患者中,肺静脉正常无变异11例,占17．19％;肺静脉提前分支45例,占70．31％,共69支肺静脉;左侧共干5例,占7．81％,其中1例两侧共干;右侧独立肺静脉5例,占7．81％;左侧中肺静脉1例,占1．56％。同侧、两侧上肺静脉的肺静脉孔指数差异无统计学意义,P〉0．05。左上与右下、左下与右上及两下肺静脉的肺静脉孔指数差异有统计学意义,P〈0．05。右下肺静脉孔最圆,平均指数最大,为0．88;左下肺静脉孔最接近椭圆型,平均指数最小,为0．72。结论多排螺旋CT肺静脉造影能为房颤射频消融术提供肺静脉解剖信息,如肺静脉变异及肺静脉孔指数,应列为术前常规检查。

Variations of pulmonary venous drainage and venous ostium index detection in atrial fibrillation patients prior to radiofrequency catheter ablation by MDCT pulmonary venography

OBJECTIVE: To evaluate variations of pulmonary venous drainage and venous ostium index (VOI) in patients with atrial fibrillation (AF) prior to radio-frequency catheter ablation (RFCA) by MDCT pulmonary venography. METHODS: 16-detector row CT pulmonary venography was performed in 64 AF patients referred to RFCA from June, 2005 to May, 2006. Variations in pulmonary venous drainage were observed in volume render imagines. Anterior-posterior and superior-inferior diameters of pulmonary venous ostium were measured on maximum intensity projection images. VOI derived from left superior, left inferior, right superior, right inferior pulmonary veins and variations in pulmonary venous drainage were calculated. RESULTS: Classic pulmonary veins anatomy was found in 11 patients (17.18%), early branching veins in 45 patients (70.31%), left common ostium in 5 patients (7.81%), right common ostia in 1 patient, right accessory (middle) pulmonary vein in 5patients (7.81%) and left accessory (middle) pulmonary vein in 1 patient (1.56%). VOI of homolateral pulmonary veins and bilateral superior pulmonary veins were similar (P > 0.05) while there was a significant difference on VOIs derived from left superior and right inferior; two inferior, left inferior versus right superior veins (P < 0.05). Right inferior pulmonary venous ostium was most rounded and had the highest index (0.88) and left inferior pulmonary venous ostium was most oval and had the lowest index (0.72). CONCLUSION: Multidetector row CT pulmonary venography (MDCT-PV) could provide valuable informations on pulmonary venous anatomy in AF patients referred to RFCA and should be used as a routine examination prior to the operation.