Maeda Shingo, Iesaka Yoshito, Uno Kikuya, Otomo Kiyoshi, Nagata Yasutoshi, Suzuki Kenji, Hachiya Hitoshi, Goya Masahiko, Takahashi Atsushi, Fujiwara Hideomi, Hiraoka Masayasu, Isobe Mitsuaki
Department of Cardiology, Musashino Red Cross Hospital, Tokyo, Japan.
Heart Vessels. 2012 Jan;27(1):58-64. doi: 10.1007/s00380-011-0120-x. Epub 2011 Feb 18.
Few studies have explored the topographic anatomy of the esophagus, posterior wall of the left atrium (LA), or fat pads using multidetector computed tomography (MDCT) to prevent the risk of esophageal injury during atrial fibrillation (AF) ablation. MDCT was performed in 110 consecutive patients with paroxysmal or persistent AF before the ablation procedure to understand the anatomic relationship of the esophagus. Two major types of esophagus routes were demonstrated. Leftward (type A) and rightward (type B) routes were found in 90 and 10% of the patients, respectively. A type A route had a larger mean size of the LA than type B. The fat pad was identifiable at the level of the inferior pulmonary vein in 91% of the patients without any predominance of either type. The thickness of the fat pad was thinner in the patients with a dilated LA (>42 mm) than in those with a normal LA size (≤42 mm) (p = 0.01). The results demonstrated that the majority of cases had a leftward route of the esophagus. There was a close association between the LA dilatation and fat pad thinning. With a dilated LA, the esophagus may become easily susceptible to direct thermal injury during AF ablation. Visualization of the anatomic relationship may contribute to the prevention of the potential risk of an esophageal injury.
很少有研究使用多排螺旋计算机断层扫描（MDCT）来探索食管、左心房后壁或脂肪垫的局部解剖结构，以预防心房颤动（AF）消融术中食管损伤的风险。在110例连续的阵发性或持续性AF患者进行消融术前，进行了MDCT检查，以了解食管的解剖关系。结果显示了两种主要的食管走行类型。分别在90%和10%的患者中发现了向左走行（A型）和向右走行（B型）。A型走行的左心房平均大小大于B型。在91%的患者中，在下肺静脉水平可识别出脂肪垫，且无任何一种类型占优势。左心房扩大（>42mm）的患者脂肪垫厚度比左心房大小正常（≤42mm）的患者更薄（p = 0.01）。结果表明，大多数病例的食管走行为向左走行。左心房扩大与脂肪垫变薄密切相关。左心房扩大时，在AF消融术中食管可能更容易受到直接热损伤。对解剖关系的可视化可能有助于预防食管损伤的潜在风险。
