MSCT在功能性单心室Fontan术后随访中的价值

目的 探讨MSCT在功能性单心室（FSV） Fontan术后随访中的价值。方法 回顾性分析32例FSV患者Fontan术后随访复查的MSCT、心血管造影（CAG）和临床资料。采用个体化手动触发双期MSCT扫描，定性评估Fontan管道和术后并发症情况，并测量双侧肺动脉起始处内径和降主动脉（膈肌水平）内径，计算McGoon指数，以评估肺动脉发育。采用Pearson相关性分析评价双侧肺动脉起始处内径与CAG测量的肺动脉舒张期压力、McGoon指数与肺血管血流阻力指数之间的关系。结果 MSCT检出3例右心房-肺动脉连接，10例全腔-肺动脉连接，11例心外Fontan管道和8例心外Y型Fontan管道；并检出8例Fontan术后并发症，包括2例肺动-静脉瘘，3例主-肺动脉侧支，2例Fontan管道附壁血栓和1例室壁瘤。MSCT测量左、右肺动脉起始处内径分别为（1.36±0.22） cm、（1.40±0.15） cm，均与CAG测量同侧肺动脉舒张期压力呈负相关（r=-0.755、-0.678，P均<0.001）。McGoon指数与肺血管血流阻力指数呈负相关（r=-0.676，P<0.001）。结论 借助快速图像获取和后处理技术，并选择个体化扫描方案，MSCT能为Fontan术后随访评估提供多项参考指标，具有重要临床应用价值。

Value of MSCT in follow-up of functional single ventricle after Fontan palliation

Objective To explore the value of MSCT in follow-up of functional single ventricle (FSV) after the Fontan palliation. Methods Data of MSCT and cardioangiography (CAG), as well as clinical information of 32 FSV patients after the Fontan procedures were analyzed retrospectively. All patients underwent MSCT examinations with individually manual triggered dual-phase scanning. Qualitative assessment of Fontan conduit structures and post-operative complications were performed. The diameters of pulmonary arteries and descending aorta at the level of diaphragm were measured to calculate McGoon index, in order to evaluate pulmonary artery development. The correlation between diameters of pulmonary artery and pressure of pulmonary artery in diastole phase, as well as between McGoon index and resistent index of pulmonary artery were analyzed. Results MSCT detected 3 cases of right atrio-pulmonary connection, 10 cases of total cavopulmonary connection, 11 cases of extracardiac Fontan and 8 cases of Y-graft Fontan conduits. Moreover, 8 cases of post-operative complications were detected with MSCT, including 2 cases of pulmonary arteriovenous malformations, 3 cases of aortopulmonary collaterals, 2 cases of mural thrombus in the Fontan pathway and 1 case of ventricular aneurysm. The diameters of left and right pulmonary artery measured on MSCT were (1.36±0.22) cm and (1.40±0.15) cm, both negatively correlated with the pressure of pulmonary artery in diastole phase (r=-0.755, -0.678, both P<0.001). McGoon index showed negative correlation with the resistent index of pulmonary artery (r=-0.676, P<0.001). Conclusion With advanced imaging post-processing technology and individual scanning scheme, MSCT can supply several important indicators in the follow-up for patients with FSV after Fontan palliation, showing important clinical value.