中老年房间隔缺损患者介入治疗前心脏CT检查的价值

目的 评估心脏CT在筛查拟行房间隔缺损(ASD)封堵术中老年患者合并的心血管病变及指导封堵器选择方面的价值。方法 对63例拟行ASD封堵术的50 ～ 77( 56.87±5.79)岁患者行冠状动脉CT造影检查,了解心血管病变情况。随后行ASD三维重建,并测量ASD大小。分析经胸超声心动图与CT的ASD直径测量值之间以及ASD直径的CT测量值与ASD封堵器腰部直径之间的关系。结果 14例患者依据心脏CT检查结果调整了治疗方案：8例患者诊断为ASD合并冠心病,均行常规冠心病治疗,其中2例患者行经皮冠状动脉介入治疗和ASD封堵术,1例患者行冠状动脉旁路移植术和ASD封堵术,5例患者行药物治疗和ASD封堵术;2例患者因ASD后下缘残端不完整,而放弃介入治疗;1例患者超声心动图示ASD后下缘残端不完整,而CT显示缺损边缘尚可,行ASD封堵术;除外ASD 1例;合并部分型肺静异位引流(PAPVC)1例,行外科修补术;合并动脉导管未闭1例,行动脉导管未闭和ASD封堵术。经胸超声心动图与CT的ASD直径测量值之间呈正相关(r=0.80,P＜0.01),其线性回归方程为Y=0.84X +8.85(R2=0.63,P＜0.05)。ASD直径的CT测量值与ASD封堵器腰部直径之间呈正相关(r=0.92,P＜0.01),其线性回归方程为y=0.93X +4.78(R2=0.84,P＜0.05)。结论 对于拟行ASD封堵术的中老年患者,术前心脏CT检查可有效诊断合并的冠心病及其他心血管畸形,并能指导封堵器的选择。

Value of cardiac CT examination in middle-aged and elderly patients with atrial septal defect before planned transcatheter closure

Objective To investigate the value of the cardiac CT examination for decision making in middle-aged and elderly patients before planned transcatheter atrial septal defect (ASD) closure. Methods Cardiac CT was performed in 63 adult patients 18 males, aged from 50 to 77 years, mean age (56. 87 ±5.79) years]with ASD before planned transcatheter ASD closure. Coronary CT angiography was made for detection of associated cardiovascular diseases, followed by 3D reconstruction of ASD for determination of the defect size in the GE-workstation, results were compared between transthoracic echocardiography measurement, CT measurement, and atrial septal defect occluder waist diameter. Results Cardiac CT identified additional cardiovascular diseases in 14 patients and decision making was changed based on cardiac CT results. Coronary artery stenosis was detected in 8 patients by cardiac CT, and proved by coronary angiography, and all of them were given comprehensive management: percutaneous coronary intervention and thanscatheter ASD closure were successively performed in 2 cases, and 1 case was referred to surgery for both coronary artery bypass graft and surgical ASD repair, and 5 patients were given pharmacological management for coronary artery disease besides thanscatheter ASD closure. Cardiac CT identified large ASD with insufficient rim tissue in 2 cases and transcatheter closures were abandoned.Cardiac CT screened out 1 case from those with insufficient posterior inferior rim by transthoracic echocardiography, and transcatheter ASD closure was successfully pedormed. Cardiac CT ruled out ASD in 1patient. In addition, cardiac CT detected 1 partial abnormalous pulmonary vein connection and 1 ductus arteriosus in this cohort. A correlation on ASD measurements was found between CT size and TTE size(r =0. 80,P ＜ 0. 01 ; Y =0. 84X + 8. 85, R2 =0. 63, P ＜ 0. 05 ), and between ASO size and CT size ( r =0. 92,P ＜ 0. 01 ; Y =0. 93X + 4. 78, R2 =0. 84,P ＜ 0. 05 ). Conclusion In middle-aged and elderly patients with ASD for possible transcatheter closure, cardiac CT is valuable on determing ASD size and morphology and could provide incremental information for optimizing clinical management for ASD patients.