Department of Pediatric Cardiac Surgery, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.
J Thorac Cardiovasc Surg. 2011 Jul;142(1):120-6. doi: 10.1016/j.jtcvs.2010.11.016. Epub 2011 Feb 3.
A detailed preoperative evaluation of coronary anatomy is mandatory before surgical intervention for tetralogy of Fallot. In pediatric patients, the preoperative evaluation of coronary anatomy has relied classically on conventional angiographic analysis and, more recently, on echocardiographic analysis, which have well-known limitations and complications. Recent technological improvements allow the use of multislice computed tomographic analysis to evaluate coronary artery anatomy in very young children, even those with high heart rates. The purpose of this prospective study was to assess the accuracy of preoperative dual-source computed tomographic analysis in detecting coronary artery abnormalities by using surgical findings as the reference standard.
We prospectively evaluated 100 patients with tetralogy of Fallot before surgical intervention between November 2006 and September 2009 by using dual-source computed tomographic analysis with either retrospective, electrocardiographically gated, helical computed tomographic analysis or prospective, electrocardiographically triggered, sequential computed tomographic acquisition. The patients had a median age of 6.8 months (range, 1.2 months-6.8 years) and a median weight of 7.9 kg (range, 3-30 kg).
Compared with surgical findings, dual-source computed tomographic analysis had 100% sensitivity and 100% specificity for detecting coronary artery abnormalities. Major coronary artery abnormalities were found in 7 (7%) patients. The radiation dose was low.
Dual-source computed tomographic analysis is an accurate and noninvasive tool for delineating coronary artery anatomy before surgical intervention in children with tetralogy of Fallot. Dual-source computed tomographic analysis might deserve to be used routinely instead of angiographic analysis and in combination with echocardiographic analysis for the preoperative assessment of patients with tetralogy of Fallot.
在法洛四联症手术干预之前，必须对冠状动脉解剖结构进行详细的术前评估。在儿科患者中，冠状动脉解剖结构的术前评估传统上依赖于常规血管造影分析，最近也依赖于超声心动图分析，但这些方法都有其已知的局限性和并发症。最近的技术进步允许使用多层计算机断层扫描分析来评估非常年幼的儿童（甚至是那些心率较高的儿童）的冠状动脉解剖结构。本前瞻性研究的目的是评估术前双源计算机断层扫描分析检测冠状动脉异常的准确性，以手术结果作为参考标准。
我们前瞻性地评估了 100 例在 2006 年 11 月至 2009 年 9 月间接受法洛四联症手术干预的患者，使用双源计算机断层扫描分析进行检查，采集方法为回顾性心电图门控螺旋计算机断层扫描分析或前瞻性心电图触发连续计算机断层扫描采集。患者的中位年龄为 6.8 个月（范围：1.2 个月-6.8 岁），中位体重为 7.9kg（范围：3-30kg）。
与手术结果相比，双源计算机断层扫描分析对检测冠状动脉异常的敏感性和特异性均为 100%。在 7 例（7%）患者中发现了主要冠状动脉异常。辐射剂量较低。
双源计算机断层扫描分析是一种准确、无创的工具，可用于在法洛四联症患儿手术干预前描绘冠状动脉解剖结构。双源计算机断层扫描分析可能值得常规用于替代血管造影分析，并与超声心动图分析联合用于法洛四联症患者的术前评估。
