Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
J Cardiovasc Electrophysiol. 2020 Apr;31(4):915-920. doi: 10.1111/jce.14386. Epub 2020 Feb 23.
The left ventricular apex commonly has a paper-thin structure. However, available data about its structure are limited to variable samples, methodologies, and results.
To investigate the structural anatomy of the left ventricular apex using living heart datasets with the latest computed tomography scanner.
One hundred thirty-one consecutive patients (median age, 73 years; 58% men) who underwent cardiac computed tomography were retrospectively analyzed. Patients with severe aortic stenosis were analyzed separately. Thickness and diameters of the thinnest part of the left ventricular apex during mid-diastole were measured using orthogonal multiplanar reconstruction images. The area of thinning was estimated using the formula for the ellipse.
In 88 patients without severe aortic stenosis, the median thickness of the thinnest area of the left ventricular apex was only 0.9 mm. Among them, 74%, 99%, and 100% of cases displayed a left ventricular apex thinner than 1.0, 3.0, and 5.0 mm, respectively. The median area of the thinnest region was 5.6 mm . In 43 patients with severe aortic stenosis, the median thickness of the thinnest area of the left ventricular apex was 1.2 mm. Among them, 51%, 93%, and 100% of cases displayed a left ventricular apex thinner than 1.0, 3.0, and 5.0 mm, respectively. The median area of the thinnest region was 3.9 mm .
Localized thinning of the left ventricular apex is unexceptional, regardless of aortic stenosis with concentric left ventricular hypertrophy, thus highlighting the need for a reappreciation of this feature to avoid inadvertent catastrophic complications.
左心室心尖通常结构菲薄。然而，目前关于其结构的数据仅限于可变的样本、方法和结果。
使用最新的计算机断层扫描（CT）扫描仪研究左心室心尖的结构解剖。
回顾性分析了 131 例连续接受心脏 CT 检查的患者（中位年龄 73 岁，58%为男性）。单独分析了严重主动脉瓣狭窄患者。使用正交多平面重建图像测量舒张中期左心室心尖最薄部分的厚度和直径。使用椭圆公式估计变薄区域的面积。
在 88 例无严重主动脉瓣狭窄的患者中，左心室心尖最薄区域的中位厚度仅为 0.9mm。其中，74%、99%和 100%的患者左心室心尖厚度分别小于 1.0、3.0 和 5.0mm。最薄区域的中位面积为 5.6mm。在 43 例严重主动脉瓣狭窄患者中，左心室心尖最薄区域的中位厚度为 1.2mm。其中，51%、93%和 100%的患者左心室心尖厚度分别小于 1.0、3.0 和 5.0mm。最薄区域的中位面积为 3.9mm。
无论是否存在伴有向心性左心室肥厚的严重主动脉瓣狭窄，左心室心尖局部变薄都很常见，因此需要重新认识这一特征，以避免意外发生灾难性并发症。
