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双源 CT 在非冠状动脉心脏手术患者中的术前冠状动脉风险评估。

Preoperative coronary risk assessment with dual-source CT in patients undergoing noncoronary cardiac surgery.

机构信息

Dipartimento di Radiologia Cardiovascolare, Ospedale San Camillo-Forlanini, Roma, Italy.

出版信息

Radiol Med. 2010 Oct;115(7):1028-37. doi: 10.1007/s11547-010-0543-y. Epub 2010 Mar 9.

Abstract

PURPOSE

The aim of our work was to assess the role of dual-source computed tomography (DSCT) in the preoperative evaluation of coronary artery disease in patients scheduled for noncoronary cardiac surgery.

MATERIALS AND METHODS

One hundred patients were prospectively evaluated. Patients negative for coronary disease at DSCT (n=81) underwent surgery without coronary angiography. Patients positive for significant lesions or with nondiagnostic image quality due to artefacts or severe calcifications underwent coronary angiography (n=19) and were excluded from the study. In patients who underwent surgery with only a DSCT diagnosis, we evaluated the frequency of major adverse cardiac events (MACEs) during the perioperative period and at 3 months follow-up.

RESULTS

No MACEs were recorded during the perioperative period; three noncardiac complications (one surgical revision for bleeding, one cardiac tamponade and one respiratory insufficiency) and one death related to severe respiratory insufficiency were observed. None of the 80 patients had MACEs during the 3-month follow-up period.

CONCLUSIONS

Coronary evaluation with DSCT is able to rule out the presence of coronary disease in patients scheduled for cardiac surgery, without the need for coronary angiography confirmation. Patients with significant stenosis or nondiagnostic image quality should be referred for coronary angiography.

摘要

目的

我们的工作旨在评估双源计算机断层扫描(DSCT)在拟行非冠状动脉心脏手术的患者中术前冠状动脉疾病评估中的作用。

材料与方法

前瞻性评估了 100 例患者。在 DSCT 上无冠状动脉疾病的患者(n=81)在未行冠状动脉造影的情况下进行了手术。DSCT 上存在明显病变或因伪影或严重钙化导致图像质量不佳的患者(n=19)行冠状动脉造影检查,并排除在研究之外。在仅根据 DSCT 诊断而行手术的患者中,我们评估了围手术期和 3 个月随访期间主要不良心脏事件(MACEs)的发生率。

结果

围手术期无 MACEs 记录;观察到 3 例非心脏并发症(1 例因出血行手术修正,1 例心脏压塞,1 例呼吸功能不全)和 1 例与严重呼吸功能不全相关的死亡。80 例患者在 3 个月随访期间均无 MACEs。

结论

DSCT 冠状动脉评估能够排除拟行心脏手术患者的冠状动脉疾病,无需冠状动脉造影证实。存在明显狭窄或图像质量不佳的患者应转诊行冠状动脉造影检查。

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