| Objectives:Patent foramen ovale(PFO)was diagnosed by electrocardiogram gated multi-slice spiral CT angiography,and the proportion of PFO patients of different classification,as well as the anatomical details of PFO and the proportion and size of left to right shunt were evaluated by conventional coronary CT angiography.Methods:A total of 1530 outpatient and inpatient patients,including 941 males and 589 females,underwent electrocardiogram gated multi-slice spiral CT angiography in china-japan union hospital of jilin university from January 2017 to October 2018.Coronary CT scanning was performed with a 320-slice spiral CT scanner from Toshiba of Japan.The patient's CT images were transferred to the post-processing workstation for reconstruction at 75% R-R intervals.The following measurements were performed on the short axis CT images:(1)Measurement 1: The length of free flaps(FV,primary septum).(2)Measurement 2: The width of open PFO channels at the intermediate points.(3)Measurement 3: The width of unclosed PFO channels at the right atrium entrance.(4)Measurement 4: The width of upper interatrial grooves(IAG,secondary septum)at the middle level.(5)Measurement 5: The length of right edges of the upper IAG(secondary septum).(6)Measurement 6: The size of oval fossa(FO)including the posterior and anterior diameters(6A)measured at four-chamber cardiac images,and the upper and lower diameters(6B)measured at the short axial images.For PFO patients associated with left-to-right shunt,the maximum lengths of lef-to-right shunt were measured at the same time.The measurement values of the above indexes were calculated for all patients with PFO,as well as for those with shunt and without left-to-right shunt,and the differences between those PFO patients with and without shunt were compared.The measured values of the above indexes for grade ?,grade ? and grade ? left-to-right shunt were calculated,respectively,and the differences among those PFO patients with different grades of left-to-right shunt were compared.Correlation analysis was performed on all the tested indicators.Results:Among the enrolled 1530 patients,PFO were found in 287 patients,accounting for 18.76% of the total patients.Among them,PFO grade ? flaps accounted for 47.39%,grade ? flaps accounted for 20.21%,and grade ? flaps accounted for 32.40%.Left-to-right shunt was observed in 93 patients,accounting for 6.08% of the total patients and 32.40% of the patients with PFO.The patients with grade ?,? and ? PFO shunt accounted for 24.39%,6.97% and 1.04% of the patients with PFO,respectively.Patients with atrial septal aneurysm accounted for 0.52% of the total number of patients and 2.78% of the patients with PFO.The probability of atrial septal aneurysm combined with left-to-right shunt was 62.5%.In this study,the upper and lower lengths of FV(primary septum)in all patients with grade ? plus ? PFO were 7.40(5.15-11.10)mm;the width of the PFO channels at the middle point was 1.90(1.60-2.30)mm;the width of the PFO channels at the right atrium entrance was 1.90(1.50-2.30)mm;the width of the upper IAGs at the middle point was 7.00(5.80-9.25)mm;the length of the right edge of the upper IAGs was(16.37±6.30)mm;the anterior and posterior diameter of FO was(13.94±4.37)mm,and the upper and lower diameter of FO was(20.51±6.29)mm.The length of the right edges of the upper IAGs was relatively shorter [(15.38±6.02)mm vs.(17.95±6.48)mm,P =0.015],and the upper and lower diameter of FO was relatively larger [(21.69±5.88)mm vs.(18.61±6.50)mm,P =0.003] in PFO patients with left-to-right shunt,in comparison with those without shunt;There were no significant differences in the rest of the measured parameters between patients with and without shunt(P >0.05).Compared with PFO patients with grade ? shunt,merely the width of the PFO channels at the middle point was larger in grade ? + ? patients than that of grade ? patients [2.20(1.80-2.40)mm vs.1.80(1.60-2.10)mm,P =0.006],no significant difference existed between groups in the rest of the measured parameters(P >0.05).The results of correlation analysis showed that the length of the FVs was positively correlated with the width of the PFO channels at the middle point(r =0.317,P <0.001)and the length of the right edge of the upper IAGs(r =0.458,P <0.001),respectively;The length of the FVs was negatively correlated with the width of the upper IAGs at the middle point(r =-0.253,P =0.002)and the diameter of the upper and lower IAGs(r =-0.296,P <0.001),respectively;The width of the PFO channels at the middle point was positively correlated with the width at the right atrial entrance(r =0.584,P <0.001).The width of the upper IAGs at the middle point(r =0.195,P =0.016)and the anterior and posterior diameters of FO(r =0.392,P <0.001)were in positive correlation with FO upper and lower diameters,the right edge length of supper IAGs(r =-0.302,P <0.001)were in negative correlation with FO upper and lower diameters.The length of the left-to-right shunt was positively correlated with the width of PFO channels at the middle points(r =0.282,P =0.006),and no correlation existed in the shunt length with the remaining tested parameters(P >0.05).Conclusion:In this study,we found that multi-slice spiral CT angiography could clearly display the morphology of the primary and secondary septum of PFO,the anatomical details of the open channels and the left-to-right shunt,as well as the precious and quantitative measurement of PFO-related anatomy could be achieved. |
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