Wang Si-Lun, Ooi Clara G C, Siu Chung-Wah, Yiu Michael W C, Pang Cby, Lau Chu-Pak, Tse Hung-Fat
Department of Diagnostic Radiology, The University of Hong Kong, and Department of Radiology, Queen Mary Hospital, Hong Kong.
Pacing Clin Electrophysiol. 2006 May;29(5):502-8. doi: 10.1111/j.1540-8159.2006.00384.x.
The close proximity of left atrium (LA) and esophagus during radiofrequency ablation for atrial fibrillation (AF) predisposes to thermal injury resulting in atrio-esophageal fistula. This work proposes to study the anatomic relationship between the esophagus and the LA wall using multidetector computed tomography (MDCT) three-dimensional (3D) "Navigator" reconstruction technique.
Forty-five consecutive patients (37 men, mean age 52.7+/-14.1 years) with preradiofrequency ablation MDCT scans of the thorax for AF were recruited. Length and type (continuous or interrupted) of fat pad between esophagus and LA were evaluated. The position, width, and length of the esophagus in contact (without fat pad) with the LA were determined by using "Navigator" software on the endocardial view of LA.
The fat pad was continuous in 4% (2 of 45) and interrupted in 96% (43 of 45) patients. The mean width and length of esophageal-LA contact in 43 cases with interrupted fat pad was 24.0+/-5.8 mm (range 10.5-35.3 mm) and 41.9+/-11.6 mm (5.4-64 mm), respectively. There was an inverse relationship between the lengths of the esophageal-LA contact and the upper fat pad (r=-0.50, P=0.001). The esophagus was located to the left, right, and midline of the LA in 40, 2, and 1 patients, respectively, and the esophagus was in contact with and overrode the PV orifice in 22 and 4 patients, respectively.
Direct esophageal-LA contact without the intervening fat pad was present in 96% of the cases, with 93% of esophagi lying to the left of the LA and 51% in contact with a PV orifice. Three-dimensional Navigator imaging technique has enhanced the visualization of the anatomical information of the esophagus, LA wall, and PV orifices that may be used to avoid thermal injury to the esophagus during LA ablation procedure.
在房颤（AF）射频消融治疗过程中，左心房（LA）与食管位置紧邻，易导致热损伤，进而引发心房食管瘘。本研究旨在运用多排螺旋计算机断层扫描（MDCT）三维（3D）“导航器”重建技术，研究食管与左心房壁之间的解剖关系。
连续纳入45例接受房颤射频消融术前胸部MDCT扫描的患者（37例男性，平均年龄52.7±14.1岁）。评估食管与左心房之间脂肪垫的长度及类型（连续或中断）。通过在左心房心内膜视图上使用“导航器”软件，确定与左心房接触（无脂肪垫）的食管的位置、宽度和长度。
4%（45例中的2例）患者的脂肪垫连续，96%（45例中的43例）患者的脂肪垫中断。43例脂肪垫中断患者的食管-左心房接触平均宽度和长度分别为24.0±5.8mm（范围10.5 - 35.3mm）和41.9±11.6mm（5.4 - 64mm）。食管-左心房接触长度与上部脂肪垫长度呈负相关（r = -0.50，P = 0.001）。食管分别位于左心房左侧、右侧和中线的患者有40例、2例和1例，食管分别与22例和4例肺静脉口接触并越过肺静脉口。
96%的病例存在无中间脂肪垫的食管与左心房直接接触，93%的食管位于左心房左侧，51%与肺静脉口接触。三维导航成像技术增强了食管、左心房壁和肺静脉口解剖信息的可视化，可用于在左心房消融手术中避免食管热损伤。
