64层螺旋CT在心律失常及瓣膜介入术中的应用价值

目的 探讨房性心律失常射频消融术及二尖瓣狭窄球囊扩张术前,应用64层螺旋CT检测患者左心耳血栓的临床价值.方法 需行房扑、房速、房颤射频消融术或二尖瓣狭窄球囊扩张术患者204例,术前常规行左房及肺静脉CT血管成像(CTA)检查,有左房血栓的病例作为实验组,未提示左房血栓的病例作为对照组,所有病例均行经食道超声检查(TEE).结果 204例患者中,64层螺旋CT检查显示左心耳血栓形成者32例,未见血栓征象者172例,TEE检查显示左心耳血栓形成者26例,无血栓征象者178例,CT显示的32例血栓中,22例经TEE证实,10例TEE显示为自发超声显影(SEC).CT显示的未见血栓征象者172例中,168例经TEE证实,另4例TEE显示为血栓形成.64层螺旋CT诊断左心耳血栓的敏感性84.6％,特异性94.4％,阳性预测值68.8％,阴性预测值97.7％,准确度93.1％.结论 64层螺旋CT检测房性心律失常射频消融术及二尖瓣狭窄球囊扩张术患者左心耳血栓具有较高的临床应用价值,未来有可能成为临床上检测左心耳血栓的一种无创、可靠的替代方法.

The value of 64 slice spiral CT on the interventional therapy of the arrhythmia or the valvula

【Objective】 To evaluate the value of 64.slice spiral CT in detection of left atrial appendage(LAA) thrombus before the radiofrequency ablation of the atrial arrhythmia and the balloon catheter technique of the mitral valve stenosis.【Methods】 64.slice spiral CT scanning was performed to detect the left atrial and the pulmonary veins in 204 patients with auricular flutter(AF),atrial tachycardia(AT) and fibrillation atrial(AF) before radiofrequency ablation or the balloon catheter technique of the mitral valve stenosis,those who were found left atrial thrombus were enrolled as experimental group,and cases without left atrial thrombus were regard as control group,All patients underwent transesophageal echocardiography(TEE) as a reference standard.【Results】 32 thrombi in LAA were detected with 64.slice spiral CT,of which 22 were detected with TEE,and spontaneous echo contrast-was detected with TEE in the other 10 patients.172 without thrombi signs.26 thrombi in LAA were detected with TEE,178 without thrombi sign.Of the 172patients without thrombi signs detected with 64.slice spiral CT,168 were certified with TEE,4 thrombi in LAA were detected with TEE.Used as the reference standard with TEE,the overall sensitivity,specificity,positive predictive value,negative predictivevalue and accuracy of 64.slice spiral CT for detecting thrombus were 84.6%,94.4%,68.8%,97.7%and 93.1%,respectively.【Conclusion】 The 64.slice spiral CT has the higher clinical value on the detection of the left atrial appendage(LAA) thrombus before the radiofrequency ablation of the atrial arrhythmia and the balloon catheter technique of the mitral valve stenosis,it may be a reliable substitution method for the detection of LAA thrombus without injury in the future.