CAJ | 학술논문

目的探讨多排螺旋CT血管造影(MUCTA)三维重建应用于小儿法乐四联症(TOF)诊断及治疗中的价值.方法 2004年12月至2008年12月38例经胸二维超声心动图(TEE)诊断TOF患儿,为进一步明确肺动脉发育状况行MUCTA检查,均经外科手术证实.MUCTA扫描后应用三维重建处理,测算全肺动脉指数(Nakata),确定肺动脉发育状况,冠状动脉走向,主、肺动脉侧枝循环位置,设计手术方案.结果 38例患儿检查过程顺利均为TOF,其中合并房间隔缺损(ASD)3例、动脉导管未闭(PDA)2例、室间隔缺损(VSD)嵴下型38例,单纯右室流出道狭窄7例、合并肺动脉狭窄31例,冠状动脉走向异常2例、主、肺动脉侧枝循环19例、其中粗大侧枝循环3例.35例康复出院,3例术后死亡.结论 MUCTA对于诊断TOF心外畸形的显示清晰度超过其它影像学检查,特别是对观察肺动脉发育形态、肺动脉狭窄的部位、冠状动脉起源与走向异常、PDA、主肺动脉侧枝循环,精确测算Nakata指数、McGoon指数均有明显帮助.与TEE相结合能达到优势互补、能够更加完整、准确的诊断TOF,为手术决策,方案的制定提供了有效的依据,对提高TOF患儿的治疗效果有重要价值.
목적 탐토다배라선CT혈관조영(MUCTA)삼유중건응용우소인법악사련증(TOF)진단급치료중적개치.방법 2004년12월지2008년12월38례경흉이유초성심동도(TEE)진단TOF환인,위진일보명학폐동맥발육상황행MUCTA검사,균경외과수술증실.MUCTA소묘후응용삼유중건처리,측산전폐동맥지수(Nakata),학정폐동맥발육상황,관상동맥주향,주、폐동맥측지순배위치,설계수술방안.결과 38례환인검사과정순리균위TOF,기중합병방간격결손(ASD)3례、동맥도관미폐(PDA)2례、실간격결손(VSD)척하형38례,단순우실류출도협착7례、합병폐동맥협착31례,관상동맥주향이상2례、주、폐동맥측지순배19례、기중조대측지순배3례.35례강복출원,3례술후사망.결론 MUCTA대우진단TOF심외기형적현시청석도초과기타영상학검사,특별시대관찰폐동맥발육형태、폐동맥협착적부위、관상동맥기원여주향이상、PDA、주폐동맥측지순배,정학측산Nakata지수、McGoon지수균유명현방조.여TEE상결합능체도우세호보、능구경가완정、준학적진단TOF,위수술결책,방안적제정제공료유효적의거,대제고TOF환인적치료효과유중요개치.
Objective To evaluate the multidetector-row computed tomography angiography (MUCTA) used in diagnosis and treatment of children with Tetralogy of Fallot (TOF).Methods Between December 2004 and December 2008,38 patients with TOF were assessed using eeho-doppler (TTE) and MUCTA.Three dimensional images were constructed to assess the pulmonary artery anomalies,anomalies of the coronary artery and aorta-pulmonary collateral arteries.McGoon and Nakata indiees were obtained in preparation for corrective surgery.Results A total of 38 patients were scanned using MUTCA and anomalies were diagnosed as TOF with ventricular septal defects (VSD).Two of these patients also had atrial septal defects (ASD) and three had patent ductus arteriosus (PAD).Seven had right ventricular outlet stenosis.Thirty-one patients with arterial stenosis including pulmonary arterial branch stenosis,six with left sided and eight with right sided stenosis all of which developed pulmonary arterial branch enlargement.Two had coronary artery anomalies,nineteen had aorta-pulmonary anomalies which three of these had enlarged collaterals.With the use of MUCTA and TTE,we were able to plan the surgieal procedures pre-operatvely.This was otherwise not possible.Thirty-five of the patients recovered while the remaining three patients died peri-operatively.Conclusions MUCTA is a more accurate imaging than other modalities for the assessment of pulmonary artery.