右心室雙出口之三度空間立體電子射束電腦斷層心血管攝影(2/2)

Abstract

本計劃的目的為評估電子射束電腦斷 層掃描攝影（EBCT）及其三度空間立體組 像在先天性心臟病中右心室雙出口 （DORV）的應用。在過去24 個月中，吾 等收集了43 個DORV 的病例(男：女=26： 17 ; 年齡=5 天~10 歲10 月) 。所有的病人 都是接受靜脈注射顯影劑之EBCT 的檢 查，且其影像取得皆位於終心舒張期時。 重組的3D 影像採用漸層陰影的表面呈現 模式。共有主動脈下（n=12），肺動脈下 （n=17），非共通性（n=13）以及雙共通 性(n=1) ， 這幾種型式的心室中隔缺損 （VSD）被看到。主動脈下VSD 者，其 VSD 的上緣就剛好落在主動脈環的下方。 肺動脈下VSD 型者，同理其VSD 的上緣 就會剛好落在肺動脈環的下方。非共通性 VSD 型者，其VSD 的上緣遠離任何一個大 動脈環以及心出口隔和大動脈根。而雙共 通性VSD 型者，其兩大動脈環剛好就座落 於VSD 的上緣。進一步的3D 組像，藉由 將心臟的前面部份移除，以供更加能直接 評估心臟內部的立體結構：心室出口隔、 大動脈環根以及其與VSD之立體相關位置 和關係。

To evaluate the clinical usefulness of electron beam computed tomography (EBCT) and its reconstructed 3D imaging in demonstrating cardiac anatomy in patients with double-outlet right ventricle (DORV). In the past 24 months, 43 cases (boy : girl = 26 : 17; age = 5 days ~ 10-year-10-month) with DORV were analyzed. All EBCT images were taken at the end-diastolic phase of the cardiac cycle with intravenous injection of iodinated contrast medium. 3D reconstructed EBCT pictures were created with gradient shading surface rendering. There were sub-aortic (n=12), sub-pulmonary (n=17). non-committed (n=13) and double committed (n=1) subtypes ventricular septal defect (VSD). In sub-aortic type, pulmonary annulus located just above the VSD. In sub-pulmonary type, pulmonary annulus located just above the VSD. In non-committed type, the upper margin of VSD far away from lower margin of the outlet septum and any great arteries. In double-committed type, the upper margin of VSD just supports annulus of both great arteries. Moreover, by partially removed the anterior parts of the heart let us can evaluate the inside cardiac chambers directly for details on the ventricular outlet, great arterial root and VSD relationships.