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目的评价多层螺旋CT(MSCT)在肺静脉成像中的应用价值。方法实验组60例,均为阵发性心房颤动(房颤)患者,无器质性心脏病或仅合并高血压病；房颤发作频繁,症状重,药物治疗无效；电生理检查提示为肺静脉起源。30例肺静脉射频导管消融术术前行MSCT检查,其中13例术后3个月行MSCT检查；其余30例仅于术后3～18个月行MSCT检查。对70根肺静脉的选择性肺静脉造影结果及MSCT检查结果进行比较。对照组60例,均为非房颤患者,合并冠心病和/或高血压病,均行MSCT检查。结果肺静脉造影测量左上肺静脉30根,平均直径(18．39±5．02)mm；右上肺静脉30根,平均直径(17．97±4．89)mm；左下肺静脉10根,平均直径(15．87±6．12)mm。相应MSCT肺静脉成像所测得直径分别为(17．86±4．51)mm,(17．16±4．29)mm,(14．32±2．12)mm。共重建120例中国人肺静脉481根。3支者5例(4．2%),其中左共干者3例,右共干者2例；5支者6例(5%),其中左3支者3例,右3支者3例；4支者109例(90．8%)。房颤患者60例,MSCT肺静脉成像测得直径分别为左上肺静脉(17．02±4．13)mm,右上肺静脉(17．40±4．71)mm,左下肺静脉(14．23±3．83)mm,右下肺静脉(15．81±4．60)mm。非房颤患者60例,MSCT肺静脉成像所测得直径分别为左上肺静脉(17．97±3．32)mm,右上肺静脉(17．63±3．34)mm,左下肺静脉(15．30±2．26)mm,右下肺静脉(14．71±2．37) mm。普通消融导管组电隔离肺静脉80根,发生狭窄的10根(12．5%)；盐水灌注消融导管组电隔离肺静脉39根,发生狭窄4根(10．3%)。结论(1)中国人以4支肺静脉为主,极少部分人3支或5支；(2)盐水灌注消融导管隔离肺静脉狭窄发生率低于普通消融导管；(3)MSCT可作为无创性肺静脉消融术后随访检查手段。
Objective To evaluate the value of multi-slice spiral CT (MSCT) in pulmonary vein imaging. Methods The experimental group of 60 patients, all patients with paroxysmal atrial fibrillation (atrial fibrillation), no organic heart disease or hypertension alone; frequent episodes of atrial fibrillation, symptoms, drug treatment is invalid; electrophysiological examination prompted the pulmonary veins origin. Thirty patients with pulmonary vein radiofrequency catheter ablation were examined by MSCT preoperatively. Among them, 13 patients were examined by MSCT three months after operation and the remaining 30 patients were examined by MSCT only 3 ~ 18 months after operation. The results of selective pulmonary venography and MSCT of 70 pulmonary veins were compared. Control group, 60 patients were non-AF patients with coronary heart disease and / or hypertension, were performed MSCT. Results Pulmonary venography was performed on 30 left superior pulmonary veins with a mean diameter of (18.39 ± 5.02) mm; 30 upper right pulmonary veins with an average diameter of 17.97 ± 4.89 mm; 10 left pulmonary veins with an average diameter of 15. 87 ± 6.12) mm. The diameters of the corresponding MSCT pulmonary vein imaging were (17.86 ± 4.51) mm, (17.16 ± 4.29) mm and (14.32 ± 2.12) mm, respectively. A total of 481 Chinese pulmonary veins were reconstructed. 5 cases (4.2%) were in 3 cases, of whom 3 cases were left common and 2 cases were right common, 6 cases (5%) were in 5 cases, 3 cases in the left 3 cases and 3 cases in the right 3 cases Cases; 4 branches in 109 cases (90.8%). A total of 60 patients with atrial fibrillation were included in this study. The diameters of the left upper pulmonary vein (17.02 ± 4.13) mm, the right upper pulmonary vein (17.40 ± 4.71) mm, the left lower pulmonary vein (14.23 ± 3.83) ) mm, right lower pulmonary vein (15.81 ± 4.60) mm. The diameters of the left upper pulmonary vein (17.97 ± 3.32) mm, the right upper pulmonary vein (17.63 ± 3.34) mm, the left lower pulmonary vein (15.30 ± 2 .26) mm, right lower pulmonary vein (14.71 ± 2.37) mm. In the conventional ablation catheter group, 80 pulmonary vein were electrically isolated and 10 (12.5%) were stenosed. In the saline group, 39 pulmonary vein was electrically isolated and 4 (10.3%) stenosis occurred. Conclusions (1) The Chinese mainly consist of 4 pulmonary veins, and few of them have 3 or 5 branches. (2) The incidence of pulmonary vein stenosis isolated by saline irrigation and ablation catheter is lower than that of common ablation catheter. (3) MSCT can be used as noninvasive pulmonary vein Follow-up examination after ablation.