| IntroductionEpicardial accessory pathway (EpAP) was formed by the connection of CS and its branches with ventricle. The CS has a myocardial coat which can conduct electrical signal. The CS myocardial coat is anatomically and electrically connected to both atria, completing the accessory pathway. There are myocardial fibers that have anatomically and electrically connections with CS on the surface of MCV, PV or CS diverticula. These fibers connect with ventricle and become the pathway between CS and ventricle, that is mamed as EpAP. Our another study found the ideal ablation sites of EpAP in about two thirds patients situate within 2mm away from CA whether the AP locate at MCV or PV in patients without CS deformity. And ablation within 2mm away from CA results in CA injury in two thirds patients, even AMI. Up to now, the relationship between CS and CA is confirmed only relying on CS and coronary angiography, but no non-invasive method, multislice spiral CT coronary angiography (MSCTA) has been proved having high identity with coronary angiography in determining CA diseases now. So this study is to confirm the relationship between CS and CA with three-dimensional restruction in multi-slice spiral CT, and compare the results with that of angiography.Subjects And MethodsSubjects20 patients including 11 men and 9 women were studied. Age is 33 ~73 years old,average age is 52.2 ± 13.1 years old . Among them 16 patients undergone RF and 4 patients undergone PCI. Among them 12 patients undergone 16-slice MSCTA and 8 patients undergone 64-slice MSCTA.MeasurementsWe selected the images of CAG and CVG, then observed the running of CS and its branches, measured the vessels diameters of CS by computer software, e-valuated the relationship between CA and CS. We rebuilt CA and CS with MSCT. After that ,we measured the corresponding data and evaluated the same relationship between CA and CS with MSCT.Statistical analysisWe calculated the displaying rate of vessels separately between angiography and MSCTA. With the results of CAG and CVG as gold standard, we calculate the sensitivity, specificity, positive predictive value, negative predictive value and reliability of MSCTA. The data were showed with x ± s. The correlation between two groups data was analyzed with linear regression.Results1. Comparement of CAG and MSCTA:20 cases had image in CAG, 8 were left CA superiority, and 12 were right CA superiority. The result with CT is in accord with this. With the standard of measuring diameters of vessels in CAG , all arteries with diameter above 2mm had imaged in MSCTA, and 100% of arteries with diameter above lmm had imaged iri MSCTA,too.2. Comparement of CVG and MSCTA:18 had normal CS among 20 cases performed with CVG and 2 had permanent left-superior cavity deformity. With the result of CVG as gold standard,wecalculated the displaying rate of CS and its branches, all veins had imaged in MSCTA. 2 cases with deformity both had MCV, but no PV.3. The relationship between CA and CS, MCV, PV:In angiography, the circumflex and the CS showed the same proceeding in 16 cases till separating at 39.3 ± 22.6mm far from ostium of MCV. 17 cases had circumflexes more than 5mm far away from MCV. 6 cases had circumflexes in-tersectant with MCV, and the intersection was 7.6 ±8. Omm apart from ostium of MCV. The results of CT were in full accord with the above. 14 cases had RA branching into posterior descending and left posterior arteries. 6 cases had posterior artery of left ventricle intersectant with MCV, and the intersection was 7. 9 ±5. lmm far from MCVO. 9 cases had posterior descending artery intersectant with MCV, and the intersection was 16.8 ± 5.3mm away from ostium of MCV. 3 cases had no intersection between MCV and RA, and the nearest site between them was 12. 8 ± 10. 8mm away to MCV. With the result of CAG and CVG as gold standard,we calculated the sensitivity 98. 0% , specificity 100. 0% , positive predictive value 100.0% , negative predictive value 97. 1% and reliability 98.8%.4. Measuring data comparement of CAG, CVG and MSCTA:MCV existed in all cases. We measured the distance between MCV and ostium of CS ( CSO} , between PV and CSO. We also measured the diameter of MCVO t PVO and CSO respectively. Turning toward GCV, CS became slenderer gradually. We calculated the diameters of CS where were 1.5cm and 3.0cm far from CSO respectively. Comparing with angiography, CS and MCV could all be seen in MSCTA and had the same running with that in angiography; diameters of CSO, MCV and PV measured in MSCTA were in high correlation( P <0. 001) with those in angiography.Conclusion1. Results of CA:This studie evaluates the displaying rate of vessels with diameter above lmm. The reliability of MSCTA is 100%.
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