Matsumoto Yuji, Krishnan Subramaniam, Fowler Steven J, Saremi Farhood, Kondo Takeshi, Ahsan Chowdhury, Narula Jagat, Gurudevan Swaminatha
Division of Cardiology, Department of Medicine, University of California, Irvine, California, USA.
Am J Cardiol. 2007 Jul 1;100(1):133-7. doi: 10.1016/j.amjcard.2007.01.072. Epub 2007 May 21.
The improved temporal and spatial resolution allowed by multidetector computed tomography (MDCT) has facilitated the noninvasive assessment of cardiac anatomy before transcatheter electrophysiologic procedures. Clarification of spatial relations of phrenic nerves and key cardiac structures is important to decrease potential complications. The purpose of this study was to reconstruct the course of the right and left phrenic pericardiophrenic bundles and their relations to cardiac structures using 64-slice MDCT. One hundred six consecutive subjects (age 61 +/- 13 years; 39% women) who underwent self-referred coronary computed tomographic angiography using 64-slice MDCT underwent retrospective assessment of the phrenic nerves contained within the pericardiophrenic bundles. The course of the nerves was outlined in relation to the left atrial appendage, coronary sinus, and cardiac veins. The ability to individually detect the left and right phrenic nerves, as well as the frequency of direct contact between the left phrenic nerve and cardiac veins, was recorded. The left phrenic nerve was identified in 78 of 106 patients (74%). It crossed the left atrial appendage (n = 72, 91%), great cardiac vein (n = 63, 80%), posterior vein of the left ventricle (n = 39, 49%), posterior interventricular vein (n = 8, 10%), and anterior interventricular vein (n = 7, 9%). Mean Hounsfield units (HUs) of the left phrenic nerve was 81 +/- 25. The right phrenic nerve was identified in 50 of 106 patients (47%). Mean HUs of the right phrenic nerve were 94 +/- 26. In conclusion, cardiac imaging using 64-slice MDCT enabled adequate detection of the left and right phrenic nerves in relation to cardiac anatomy. In the setting of electrophysiologic interventions, MDCT before a procedure may elucidate anatomic relationships and help minimize inadvertent complications.
多排螺旋计算机断层扫描（MDCT）所带来的时间和空间分辨率的提高，有助于在经导管电生理手术前对心脏解剖结构进行无创评估。明确膈神经与关键心脏结构的空间关系对于减少潜在并发症很重要。本研究的目的是使用64排MDCT重建左右膈神经心包膈束的走行及其与心脏结构的关系。106例连续接受64排MDCT自限性冠状动脉计算机断层血管造影的受试者（年龄61±13岁；39%为女性），对心包膈束内的膈神经进行回顾性评估。勾勒出神经相对于左心耳、冠状窦和心脏静脉的走行。记录单独检测左右膈神经的能力，以及左膈神经与心脏静脉直接接触的频率。106例患者中有78例（74%）识别出左膈神经。它穿过左心耳（n = 72，91%）、大心脏静脉（n = 63，80%）、左心室后静脉（n = 39，49%）、后室间静脉（n = 8，10%）和前室间静脉（n = 7，9%）。左膈神经的平均亨氏单位（HUs）为81±25。106例患者中有50例（47%）识别出右膈神经。右膈神经的平均HUs为94±26。总之，使用64排MDCT进行心脏成像能够充分检测与心脏解剖结构相关的左右膈神经。在电生理干预的情况下，术前MDCT可能有助于阐明解剖关系并有助于将意外并发症降至最低。
