Hauser Thomas H, Yeon Susan B, Kissinger Kraig V, Josephson Mark E, Manning Warren J
Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
Am Heart J. 2006 Nov;152(5):974.e1-6. doi: 10.1016/j.ahj.2006.05.018.
Understanding pulmonary vein (PV) anatomy is important for the planning and execution of PV isolation for the treatment of atrial fibrillation, screening for PV stenosis after the procedure, and investigating the pathophysiology of atrial fibrillation. We hypothesized that significant changes in PV size occur during the cardiac cycle and sought to identify the relationship of data obtained with conventional non-electrocardiogram (ECG)-gated methods compared with ECG-gated measures of PV size using cardiovascular magnetic resonance.
A consecutive series of 14 patients in sinus rhythm were evaluated with non-ECG-gated contrast-enhanced magnetic resonance angiography and ECG-gated cine cardiovascular magnetic resonance of the PV. Pulmonary vein diameter, perimeter, and cross-sectional area (CSA) were measured using both methods.
Maximum diameter, perimeter, and CSA occurred simultaneously in all PV. The timing of the maximum size varied but generally occurred in ventricular diastole (101 +/- 112 milliseconds after mitral valve opening). The timing of minimum PV size also varied but generally occurred in ventricular systole (212 +/- 90 milliseconds before mitral valve opening). The difference between the maximum and minimum PV size was 15% +/- 8% for diameter, 15% +/- 7% for perimeter, and 27% +/- 12% for CSA (P < .001 for all). Contrast-enhanced magnetic resonance angiography correlated best with the ECG-gated maximum PV size (R2 > 0.48, P < .001 for all) and was greater than the minimum and average PV sizes (P < .05 for all).
All measures of PV size vary significantly during the cardiac cycle. Contrast-enhanced magnetic resonance angiography PV measurements correlate best with maximum PV size.
了解肺静脉（PV）解剖结构对于房颤治疗中肺静脉隔离的规划与实施、术后肺静脉狭窄筛查以及房颤病理生理学研究均具有重要意义。我们推测在心动周期中肺静脉大小会发生显著变化，并试图确定传统非心电图（ECG）门控方法所获数据与使用心血管磁共振的ECG门控肺静脉大小测量结果之间的关系。
对连续14例窦性心律患者进行非ECG门控对比增强磁共振血管造影和ECG门控肺静脉电影心血管磁共振检查。使用这两种方法测量肺静脉直径、周长和横截面积（CSA）。
所有肺静脉的最大直径、周长和CSA同时出现。最大尺寸出现的时间各不相同，但通常发生在心室舒张期（二尖瓣开放后101±112毫秒）。肺静脉最小尺寸出现的时间也各不相同，但通常发生在心室收缩期（二尖瓣开放前212±90毫秒）。肺静脉最大和最小尺寸之间的差异为：直径15%±8%，周长15%±7%，CSA 27%±12%（所有P值均<0.001）。对比增强磁共振血管造影与ECG门控的肺静脉最大尺寸相关性最佳（R2>0.48，所有P值均<0.001），且大于最小和平均肺静脉尺寸（所有P值均<0.05）。
在心动周期中，肺静脉大小的所有测量值均有显著变化。对比增强磁共振血管造影测量的肺静脉尺寸与最大肺静脉尺寸相关性最佳。
