MSCT Diagnosis Of Congenital Malformation Of Congenital Heart Disease With Coronary Artery Anomalies In Infants

Cone arterial stem is the tubular structure between the heart and the bow artery during embryonic development,and its developmental malformations can lead to a complex congenital heart malformation.Cardiac congenital arterial dry deformity is a group of severe,complex violet congenital heart disease,including tetralogy of Fallot,permanent arterial stem,pulmonary atresia,right ventricle double outlet,complete transposition of major arteries,main-pulmonary artery septal defect A variety of causes of cyanosis and hypoxemia in the heart deformity.Distal cardiac abnormalities caused by congenital malformations are a very important type of congenital heart disease.The presence or absence of cones in the semilunar regimen during embryonic development determines the position of the aorta and its connection with the ventricle to a certain extent.The size of the cones determines the relative relationship between the upper and lower sides of the upper half of the valve,the upper and lower relative relationship between the conical artery stem separation and the right hand is not sufficient or the development of the cone artery dry,resulting in the aorta can not completely ride around the left and right ventricle,Tetralogy of Fallot is due to the reverse rotation of the conical artery stem interval,if the interval is not developed to form permanent arterial stem,and the main-pulmonary artery septal defect is due to incomplete development of the cone artery stem interval;pulmonary artery The developmental abnormalities of the conical arteries below the flap leads to pulmonary atresia with ventricular septal defect.These congenital cardiac abnormalities caused by congenital heart structure abnormalities in the early treatment if not timely,the prognosis is poor,nearly half died in infancy,and early surgical treatment depends on the early implementation of this type of congenital heart disease accurate diagnosis.Coronary artery origin(abnormalcous origin of the coronary arteries),including coronary origin originated in the abnormal position of the aortic sinus,coronary artery abnormalities and coronary artery abnormalities originated in the pulmonary artery.The incidence rate accounts for about 1% of congenital heart disease,mainly in the process of embryonic development of coronary artery to the aortic sinus process error caused by coronary artery origin in the aortic sinus abnormal position.Single coronary artery malformation and coronary origin originate in the pulmonary artery often associated with congenital heart disease,due to increased blood supply,can cause myocardial ischemia,angina,myocardial infarction or death,is a potentially dangerous type of coronary artery abnormalities.If a single coronary artery atherosclerosis,may cause serious adverse consequences,mainly died of congestive heart failure.So early diagnosis and treatment is extremely important.It is particularly important to note that the discovery of coronary abnormalities is particularly important in congenital heart disease with congenital malformations.In particular,the use of arterial transposition(ASO)in the treatment of complete transposition of the great arteries(transposition of the great arteries,TGA)involving coronary artery transplantation,and a large number of literature to prove the key to ASO success is coronary artery transplantation.Therefore,coronary artery transplantation not only requires a more precise operation,accurate,gentle,but also fully understand the abnormal anatomical characteristics of coronary artery and affect the relevant factors of surgery to a more reasonable choice of transplantation,to avoid the coronary artery after transplantation,,Angle,oppression,etc.,to improve postoperative coronary perfusion,reduce complications.All of the above just shows the origin of the abnormal coronary artery and the origin of the line to make accurate judgments are necessary.And often as a diagnosis of congenital heart disease heart ultrasound for the origin of coronary artery,walking and shape of the observation by the impact of the sternum and lung can not be clearly displayed,and thus can not accurately provide coronary artery opening,walking and shape information.In recent years,MSCT heart imaging technology rapid development,a variety of new technologies emerge in an endless stream.Comprehensive and accurate assessment of cardiovascular anatomy in patients with congenital heart disease in the diagnosis and treatment of congenital heart disease occupies a pivotal position.MSCT has a great advantage in the arterial relationship and coronary artery display of congenital heart disease [ 2-3].Although there are many literatures on radiation dose,image quality,etc.of prospective ECG gating and retrospective ECG gating Made a different comparison,but the vast majority are based on adult patients.Therefore,the first part of this study will be two gated technology in children with complex congenital heart disease in the imaging quality and radiation dose for comparison.The second part of the diagnosis of congenital heart disease and coronary artery ectopic origin of the diagnosis of MSCT.Part1 Comparison of imaging quality and dose in prospective and retrospective MSCT in children with complex congenital heart diseaseObjective: To compare the diagnostic value,image quality and radiation dose of prospective ECG gating and retrospective ECG gated coronary artery CT in children with congenital heart disease.Methods: Retrospective analysis of 76 cases of congenital heart disease,which was confirmed by surgery,all patients in our hospital MSCT cardiac imaging,and record the patients' heart rate,scan time,effective dose.Line of prospective heart switch controlled switch and a retrospective heart MSCT imaging all the 38 cases of heart.76 patients were confirmed by surgery and preoperative via after sternal cardiac ultrasound(TTE)examination.All cardiac CTA images by two high qualification radiologists by double blind method of image quality evaluation,classification of quantitative criteria refer to five tables,evaluation content includes the overall image quality,opening heart cavity structure,coronary artery,coronary artery and the mainpulmonary artery showed.Results: 76 cases of children were successfully completed the scan,76 cases of children with cardiac structure,extravascular large blood vessels,coronary artery opening and trunk can clearly show that the prospective ECG gating group of effective dose and scan time And there was significant difference compared with retrospective ECG gated group(P <0.05).The mean effective dose of the prospective ECG gated group was about 76.21% lower than the retrospective ECG gated group.Conclusion:MSCT prospective ECG gated cardiac imaging is superior to retrospective ECG under the premise of ensuring image quality.It should be the first choice for MSCT in children with congenital heart disease.Part2 MSCT diagnosis of congenital malformation of congenital heart disease with coronary artery anomalies in infantsObjective: To study the type,incidence and constituent ratio of congenital malformation of coronary artery with congenital malformation of coronary artery malformation,and to discuss the importance of preoperative MSCT cardiac imaging in preoperative planning.Methods: a retrospective analysis of 276 cases of conus artery surgery proved stem malformation of congenital heart disease,all patients were in the hospital for MSCT cardiac imaging,and record the type and quantity of coronary artery origin of ectopic type of congenital heart disease,the.The incidence of the rows and columns Person chi square test to compare the coronary artery ectopic origin of different types of congenital heart disease,coronary artery of ectopic origin of different congenital heart disease compared using the Fisher exact test were compared.Compared with surgical results,the importance of preoperative MSCT cardiac imaging in preoperative planning was discussed.Results: a total of 276 cases of malformation of congenital heart disease stem tapered artery,47 cases with ectopic origin of coronary artery,the average incidence rate was 17%,of which 11 cases of pulmonary atresia with PA,15 cases of transposition of the great arteries of TGA,4 cases of tetralogy of Fallot TOF PTA,6 cases of persistent truncus arteriosus,double port DORV right ventricle in 11 cases.In this group of conotruncal defects of congenital heart disease with coronary artery ectopic origin,single coronary artery SCA the most,accounting for 48.94%,followed by the contralateral coronary artery or non coronary sinus origin OO,accounting for 29.79%,multiple coronary artery origin MO accounted for 14.89%,HO for 4.26% high origin of coronary artery,artery coronary artery and pulmonary PO at least,accounting for 2.13%.Comparison of Fisher exact test,chi square value is 15.452,P value is 0.472,that of coronary artery ectopic origin of different types of congenital heart disease in which there were no significant differences,can be considered to constitute a different ratio of coronary artery ectopic origin of different types of congenital heart disease,but the proportion of TGA reached 32%.Conclusion: the deformity of congenital heart disease with coronary artery ectopic origin different conotruncus incidence and constituent ratio of different severity,associated with conotruncal defects,the incidence of ectopic origin of coronary artery from high to low was PTA(35.3%)>TGA(27.3%)>DORV(25%)>PA(16.9% >TOF)(4.2%).However,transposition of the great arteries(TGA)are the highest,reaching 32%,said we should pay more attention to TGA associated with coronary artery ectopic origin in children,because coronary artery transplantation is the arterial switch operation(ASO)the key to success,and affect the prognosis and survival rate.Therefore,preoperative MSCT cardiac imaging clearly shows that the type of congenital malformation of the coronary artery,and the opening of the coronary artery is of great significance for preoperative planning.