Omran H, Pfeiffer D, Tebbenjohanns J, Schumacher B, Manz M, Lauck G, Hagendorff A, Jung W, Fehske W, Lüderitz B
Department of Cardiology, University of Bonn, Germany.
Pacing Clin Electrophysiol. 1995 Jun;18(6):1236-43. doi: 10.1111/j.1540-8159.1995.tb06963.x.
To determine the value of echocardiography for identifying coronary sinus (CS) diverticula and middle cardiac veins (MCVs) in patients with posteroseptal accessory pathways (PAPs), transthoracic (TTE) and transesophageal echocardiography (TEE) were performed in 18 consecutive patients with PAP and in 15 control subjects with left lateral accessory pathway before CS angiography. The size, shape, and location of CS diverticula and MCV were described and compared to angiography. TEE and angiography were concordant for the identification of diverticula (n = 5) and agreed for depicting MCV in 22 of the 27 cases. TTE revealed 4 of 5 diverticula and identified 4 of 27 MCV (P < 0.001). Fourteen MCV but no diverticula were found in the control subject. There was no significant difference between transesophageal and angiographic measurements for the width (23.5 +/- 4.9 vs 26.8 +/- 6.6 mm) and height (13.5 +/- 3.8 vs 15.7 +/- 3.4 mm) of the diverticula, and the width (3.5 +/- 0.7 vs 3.7 +/- 0.6 mm) of MCV. TEE underestimated the length of the MCV (12.0 +/- 1.8 vs 27.2 +/- 6.0, P < 0.001). Delivery of radiofrequency energy within the neck of a diverticulum or within an MCV was successful in 5 of 5, and 6 of 13 cases in patients with PAPs, respectively. In conclusion, echocardiography was as reliable as angiography for detecting and describing CS diverticula and MCV in patients with preexcitation syndrome. Echocardiography is recommended prior to electrophysiological study because it may simplify radiofrequency catheter ablation.
为确定超声心动图在识别后间隔旁道（PAP）患者冠状窦（CS）憩室和心中静脉（MCV）方面的价值，在18例连续的PAP患者以及15例左侧旁道对照受试者中，于CS血管造影前进行了经胸超声心动图（TTE）和经食管超声心动图（TEE）检查。描述了CS憩室和MCV的大小、形状及位置，并与血管造影结果进行比较。TEE与血管造影在识别憩室方面结果一致（n = 5），在27例中有22例在描绘MCV方面结果相符。TTE检出了5个憩室中的4个，识别出了27条MCV中的4条（P < 0.001）。在对照受试者中发现了14条MCV，但未发现憩室。经食管测量与血管造影测量的憩室宽度（23.5±4.9对26.8±6.6 mm）、高度（13.5±3.8对15.7±3.4 mm）以及MCV宽度（3.5±0.7对3.7±0.6 mm）之间无显著差异。TEE低估了MCV的长度（12.0±1.8对27.2±6.0，P < 0.001）。在PAP患者中，分别有5例中的5例以及13例中的6例在憩室颈部或MCV内成功进行了射频能量传递。总之，在检测和描述预激综合征患者的CS憩室和MCV方面，超声心动图与血管造影同样可靠。建议在电生理研究前进行超声心动图检查，因为它可能会简化射频导管消融。
