关于升主动脉腔内修复术：利用动态电影CTA洞察其动力学。

Toward endografting of the ascending aorta: insight into dynamics using dynamic cine-CTA.

作者信息

van Prehn Joffrey, Vincken Koen L, Muhs Bart E, Barwegen Gijsbrecht K W, Bartels Lambertus W, Prokop Mathias, Moll Frans L, Verhagen Hence J M

机构信息

Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands.

出版信息

J Endovasc Ther. 2007 Aug;14(4):551-60. doi: 10.1177/152660280701400418.

DOI:10.1177/152660280701400418

PMID:17696632

Abstract

PURPOSE

To evaluate pulsatility and movement along the ascending thoracic aorta using dynamic electrocardiographically-gated 64-slice cine computed tomographic angiography (CTA).

METHODS

Diameter and area change and center of mass (COM) movement of the ascending thoracic aorta was determined per cardiac cycle in 15 patients at surgically relevant anatomical levels: (A) 5 mm distal to the coronary arteries, (B) 5 mm proximal to the innominate artery, and (C) halfway up the ascending aorta. Additionally, COM movement was determined 1 cm (level P) and 2 cm (level Q) distal from the origins of the innominate, left carotid, and left subclavian arteries. Eight gated datasets covering the cardiac cycle were used to reconstruct images at each level perpendicular to the aortic lumen. The distance between important anatomical landmarks was determined.

RESULTS

All levels showed significant cardiac cycle-induced diameter and area changes (p<0.001), with the largest pulsatility 5 mm distal to the coronary arteries. Mean maximum diameter changes were (A) 17.4%+/-4.8% (range 7.5%-27.5%), (B) 13.9%+/-3.5% (range 10.6%-25.0%), and (C) 12.9%+/-3.4% (8.3%-19.6%). Mean area changes were (A) 12.7%+/-5.5% (range 4.3%-21.8%), (B) 7.5%+/-2.0% (range 4.1%-11.0%), and (C) 5.6%+/-2.2% (range 1.9%-11.4%). Mean maximum COM movements were (A) 6.1+/-2.0 mm (range 2.7-9.0), (B) 2.3+/-1.1 mm (range 1.1-5.6), and (C) 3.6+/-1.5 mm (range 1.4-6.5). Mean COM movements of the innominate, left carotid, and left subclavian arteries, respectively, were (P) 1.9+/-0.7 mm (range 0.9-3.7), 2.4+/-0.6 mm (range 1.4-3.3), and 1.9+/-0.6 mm (range 0.8-2.8), and (Q) 1.8+/-0.7 mm (range 0.8-3.5), 1.8+/-0.6 mm (range 0.8-2.7), 1.9+/-0.6 mm (range 1.1-3.4).

CONCLUSION

The dynamics of the ascending thoracic aorta and the arch vessels are impressive, showing a wide range of 3-dimensional motions. Future ascending arch branched and fenestrated thoracic endograft designs must consider this active local environment, as it may have implications for durability, sealing, and ultimate clinical success.

摘要

目的

使用动态心电图门控64层电影计算机断层血管造影（CTA）评估胸主动脉升段的搏动性和运动情况。

方法

在15例患者手术相关的解剖层面，每个心动周期测定胸主动脉升段的直径、面积变化及质心（COM）运动：（A）冠状动脉远端5mm处；（B）无名动脉近端5mm处；（C）升主动脉中点。此外，在无名动脉、左颈动脉和左锁骨下动脉起始处远端1cm（P水平）和2cm（Q水平）测定COM运动。使用覆盖心动周期的8个门控数据集在垂直于主动脉腔的每个层面重建图像。测定重要解剖标志之间的距离。

结果

所有层面均显示出显著的心动周期诱导的直径和面积变化（p<0.001），冠状动脉远端5mm处搏动性最大。平均最大直径变化为：（A）17.4%±4.8%（范围7.5%-27.5%），（B）13.9%±3.5%（范围10.6%-25.0%），（C）12.9%±3.4%（8.3%-19.6%）。平均面积变化为：（A）12.7%±5.5%（范围4.3%-21.8%），（B）7.5%±2.0%（范围4.1%-11.0%），（C）5.6%±2.2%（范围1.9%-11.4%）。平均最大COM运动为：（A）6.1±2.0mm（范围2.7-9.0），（B）2.3±1.1mm（范围1.1-5.6），（C）3.6±1.5mm（范围1.4-6.5）。无名动脉、左颈动脉和左锁骨下动脉的平均COM运动分别为：（P水平）1.9±0.7mm（范围0.9-3.7），2.4±0.6mm（范围1.4-3.3），1.9±0.6mm（范围0.8-2.8）；（Q水平）1.8±0.7mm（范围0.8-3.5），1.8±0.6mm（范围0.8-2.7），1.9±0.6mm（范围1.1-3.4）。