Wood Mark A, Wittkamp Michael, Henry Daniel, Martin Robert, Nixon J V, Shepard Richard K, Ellenbogen Kenneth A
Division of Cardiology, Virginia Commonwealth University's Medical College of Virginia, Richmond, Virginia 23298, USA.
Am J Cardiol. 2004 Jan 1;93(1):49-53. doi: 10.1016/j.amjcard.2003.09.011.
Accurate assessment of pulmonary vein anatomy is important to procedures that isolate these structures in patients with atrial fibrillation. Various modalities of pulmonary vein (PV) imaging are employed in clinical practice; however, the consistency of findings among the different modalities is unknown. The purpose of this study is to compare PV ostial anatomy by 4 common imaging techniques. Twenty-four patients undergoing catheter-based PV isolation procedures for atrial fibrillation had their PV ostial anatomy determined by cardiac computerized tomography (CT) and transesophageal echocardiography (TEE) before ablation and by intracardiac echocardiography (ICE) and venography during the ablation procedure. The number and maximal dimension of the PV ostia were determined by each imaging modality. In the 24 patients, 98 PV ostia were visualized by CT, 93 by ICE, 81 by TEE, and 71 by venography. The average ostial diameters were similar between CT (1.45 +/- 0.29 cm) and ICE (1.51 +/- 0.22 cm, p = 0.066). Compared with CT or ICE, the ostial diameters were larger with venography (1.67 +/- 0.32 cm) and smaller with TEE (1.16 +/- 0.28 cm, all p <0.001). PV ostial diameters as determined by ICE were significantly correlated with CT measurements (r = 0.57, p <0.001) and venography (r = 0.52, p <0.001). Venography measures of PV diameter were correlated with measures by CT (r = 0.33, p = 0.03). TEE measures were not correlated with any other modality (all p >/=0.43). CT identifies the greatest number of PV ostia followed by ICE. Venography overestimates and TEE underestimates ostial diameters compared with CT or ICE. The PV ostial dimensions obtained by ICE, CT, and venography are all significantly correlated.
准确评估肺静脉解剖结构对于房颤患者中隔离这些结构的手术至关重要。临床实践中采用了多种肺静脉（PV）成像方式；然而，不同方式之间检查结果的一致性尚不清楚。本研究的目的是通过4种常见成像技术比较肺静脉开口处的解剖结构。24例接受基于导管的房颤肺静脉隔离手术的患者，在消融术前通过心脏计算机断层扫描（CT）和经食管超声心动图（TEE）确定其肺静脉开口处的解剖结构，并在消融过程中通过心腔内超声心动图（ICE）和静脉造影确定。每种成像方式均确定肺静脉开口的数量和最大直径。在这24例患者中，CT显示98个肺静脉开口，ICE显示93个，TEE显示81个，静脉造影显示71个。CT（1.45±0.29cm）和ICE（1.51±0.22cm，p = 0.066）的平均开口直径相似。与CT或ICE相比，静脉造影的开口直径更大（1.67±0.32cm），TEE的开口直径更小（1.16±0.28cm，所有p<0.001）。ICE测定的肺静脉开口直径与CT测量值（r = 0.57，p<0.001）和静脉造影（r = 0.52，p<0.001）显著相关。静脉造影测量的肺静脉直径与CT测量值相关（r = 0.33，p = 0.03）。TEE测量值与任何其他方式均无相关性（所有p≥0.43）。CT识别出的肺静脉开口数量最多，其次是ICE。与CT或ICE相比，静脉造影高估了开口直径，而TEE低估了开口直径。ICE、CT和静脉造影获得的肺静脉开口尺寸均显著相关。
