本文選題：經(jīng)胸超聲心動圖 + 冠狀動脈瘺��； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討經(jīng)胸超聲心動圖(transthoracic echocardiography,TTE)對冠狀動脈瘺(coronary artery fistula,CAF)診斷的應(yīng)用價值及了解術(shù)后心臟解剖形態(tài)及功能的變化。方法:回顧性分析我院2010年3月至2017年2月,在心血管病研究所經(jīng)外科開胸手術(shù)或經(jīng)皮穿刺CAF封堵術(shù)的37例CAF患者的臨床資料,包括:(1)收集所有CAF患者術(shù)前和術(shù)后一周內(nèi)復(fù)查的TTE各項測量指標(biāo):左室收縮末期內(nèi)徑(LVESD)、左室舒張末期內(nèi)徑(LVEDD)、右室舒張末期前后徑(RVEDD)、左房前后徑(LAAPD)、左房左右徑(LATD)、右房左右徑(RATD)、左室縮短率(LVFS)、左室射血分?jǐn)?shù)(LVEF)、左、右冠狀動脈起始部主干內(nèi)徑(RCAD/LCAD)、瘺入部位、瘺口內(nèi)徑及瘺口處血流速和壓差、各瓣膜反流及術(shù)后殘余瘺情況。(2)對比術(shù)前冠脈CT增強(CT angiography,CTA)和選擇性冠狀動脈造影(selective coronary arteriography,SCA)檢查準(zhǔn)確率。(3)記錄手術(shù)病理及手術(shù)方式。結(jié)果:所有CAF病例均經(jīng)手術(shù)證實,TTE、SCA、冠脈CTA的CAF診斷準(zhǔn)確率分別為89.1%、95.7%和96.8%。單支冠狀動脈瘺36例(97.2%),其中右冠狀動脈瘺21例(58.3%),左冠狀動脈瘺15例(41.6%);雙側(cè)冠狀動脈瘺僅1例(2.7%)。病變冠狀動脈瘺入右心系統(tǒng)共35例(94.5%),其中入右室16例(43.2%),入右房14例(37.8%),入肺動脈5例(13.5%);瘺入左心系統(tǒng)僅2例(5.4%)。21例行修補術(shù)(其中1例行經(jīng)皮穿刺CAF封堵術(shù)未成功,后轉(zhuǎn)修補術(shù)),8例行結(jié)扎術(shù),4例行縫閉術(shù),4例行經(jīng)皮穿刺CAF封堵術(shù)。術(shù)后心臟形態(tài)學(xué)各測量指標(biāo)、病變冠脈起始部主干內(nèi)徑均較術(shù)前降低,與術(shù)前比差異均有統(tǒng)計學(xué)意義(P0.05);19例CAF術(shù)后患者心臟形態(tài)恢復(fù)正常。術(shù)后LVFS、LVEF較術(shù)前略有降低但差異無統(tǒng)計學(xué)意義(P0.05)。術(shù)后6例有殘余分流。結(jié)論:TTE可應(yīng)作為CAF診斷的首選方法,是手術(shù)療效評價的有效檢查方法。
[Abstract]:Objective: to investigate the value of transthoracic echocardiography (TTE) in the diagnosis of coronary artery fistula (artery) and to understand the changes of cardiac anatomy and function after operation. Methods: the clinical data of 37 patients with CAF who underwent thoracotomy or percutaneous CAF closure in our hospital from March 2010 to February 2017 were retrospectively analyzed. (including 1) collect all the TTE measurements before and within one week after CAF: left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDDD), right ventricular end-diastolic dimension (RVEDDD), left atrial anterior and posterior dimension (LAAPD), left atrium left and right diameter (LATD), right ventricular end-diastolic dimension (LVEDDD), left ventricular end diastolic diameter (LVEDDD), left and right atrial diameter (LATD). Left ventricular shortening rate (LVFSV), left ventricular ejection fraction (LVVEF), left ventricular ejection fraction (LVEF), left ventricular shortening rate (LVFSV), left ventricular ejection fraction (LVEF), The diameter of the main trunk of the right coronary artery at the beginning of the coronary artery was RCAD / LCAD, the location of the fistula, the internal diameter of the fistula, and the velocity and pressure difference of the blood flow at the fistula. The accuracy of coronary CT enhanced CT angiography and selective coronary angiography was compared with that of selective coronary angiography (SCA3) to record the operation pathology and the operation method of each valve regurgitation and postoperative residual fistula. Results: all cases of CAF were confirmed by operation. The diagnostic accuracy of CAF of coronary CTA was 89.1% and 96.880% respectively. There were 36 cases of single coronary artery fistula, including 21 cases of right coronary artery fistula, 15 cases of left coronary artery fistula, 1 case of bilateral coronary artery fistula, and 1 case of bilateral coronary artery fistula, among which 21 cases had right coronary artery fistula, 15 cases had left coronary artery fistula, and 1 case had bilateral coronary artery fistula. There were 35 cases of coronary artery fistula entering the right cardiac system, including 16 cases of right ventricle, 14 cases of right atrium, 5 cases of pulmonary artery, 5 cases of fistula into left cardiac system, and 2 cases of repair of fistula into left cardiac system (including 1 case without successful percutaneous CAF closure, 1 case with percutaneous transcatheter closure of the left ventricular system), 14 cases with right atrium, 5 cases with pulmonary artery, and 2 cases with fistula into the left cardiac system. 8 cases were treated with ligation and 4 cases with suture closure and 4 cases with percutaneous CAF closure. The heart morphology and the diameter of the main coronary artery were decreased after operation, and the difference was statistically significant (P 0.05). The cardiac morphology of 19 patients after CAF was normal. LVFSU LVEF after operation was slightly lower than that before operation, but the difference was not statistically significant (P 0.05). Residual shunt was found in 6 cases after operation. Conclusion: TTE should be the first choice in the diagnosis of CAF, and it is an effective method to evaluate the curative effect of operation.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R543.3;R540.45

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