| Background and Purpose: born in China each year about 150 000 patients with congenital heart disease as much as the types up to more than 120 kinds, all kinds of variation is very complex [1], the clinical treatment of more and more difficult, family members of patients and hospitals to increase a lot of pressure, congenital heart disease more common ventricular and atrial septal defect, patent ductus arteriosus, pulmonary valve, aortic stenosis and tetralogy of Fallot, transposition great vessels and so on. Most children with physical examination at birth because of heart murmur was found, and some because of cyanosis, breathing difficulties and other symptoms which were early diagnosis.About 1 / 3 to 1 / 2 in children with congenital heart disease died due to severe heart defects within one year after birth [2]. Survivors in their growth and development of all age periods, recurrent respiratory tract infections, developmental disorders. Light can also be asymptomatic, early phase, but the presence of precordial murmur will affect children's further education and employment, if not treated, it will eventually lead to pulmonary hypertension, heart enlargement, heart failure, and some complicated endocarditis, embolism , bleeding, high blood pressure. Newborns with congenital heart disease in China accounted for about 0.7% to 0.8%, annual National 4 thousand cases of congenital heart surgery, in which more 1 / 5 for complex congenital.Heart disease, in recent years, the science and technology through continuous research, treatment of complex congenital heart De Daole great development, the complex treatment of heart disease Heart Difficulties remain, the most difficult to diagnose before mainly Shu, Mei You get accurate The lesion data, lack of adequate patients measured, complex congenital heart great vessels, the heart is too complex anatomical relationship may lead to different situations, needs to take unreasonable manner surgery, preoperative assessment of anatomic lesions of the spatial relationships, disease severity whether the establishment of collateral vessels and other important data on the clinical treatment is extremely important project.Study Methods: 65 patients in our hospital confirmed by operation of complex congenital heart, in all cases the patients underwent angiocardiography (ACG), echocardiography (UCG) and magnetic resonance imaging (MRI) examination, all lesions were classified analysis lesions of various methods for the statistical analysis of the sensitivity and specificity. Inspection of various examination methods as follows:64-slice cardiovascular CT angiography: the elbow vein or jugular vein injection of contrast medium, using iodine concentration of 370mg iodine / ml non-ionic contrast agent iopamidol, using binoculars to conduct high-pressure syringe injection of bolus contrast agent, contrast agent An 1.5ml/Kg calculated injection rate from 0.5ml / s ~ 3.0 ml / s, according to the actual situation of individual calculations to determine the injection speed, trocar 22 ~ 24G, enhanced scan with bolus tracking (bolus tracking) trigger the scanning technology, plus ECG gating technology to track blood vessels to the superior vena cava right atrium at the entrance, 8s delayed start scanning, scan parameters: 120mAs, 100KV,Scan range from apex to diaphragm 5cm, pitch 0.3, tube rotation speed: 0.33s / week, fault collimator combination 64X0.6mm, reconstruction slice thickness 0.75mm, in contrast agent injected before the pre-16ml saline injection shot to see blood vessels through the situation, to avoid leakage of contrast agent, in complete contrast agent injection after injection of contrast medium 20 ~ 30ml, to speed up the cycle of contrast agent, contrast agent to reduce the residual superior vena cava, superior vena cava to avoid caused by high concentration of contrast agent within the radioactive artifacts, film Adjacent structures such as pulmonary artery ring display. Image post-processing Methods: All patients of the original image surface reconstruction (CPR), multi-planar reconstruction (MPR), the main objective of thin projection (MIP-thin) and volume rendering techniques (VRT) and other methods of reconstruction processing, integrated use of various post-processing methods, it shows that disease, and use of measurement tools for accurate measurement of the lesion.Echocardiography: a standard of peace supine left lateral position, if necessary, unconventional position taken by left ventricular long-section, apical our-chamber, five-chamber heart, the sword and other five-chamber detection section. First of all two-dimensional ultrasonography for internal and external structure of heart, and then each section to blood flow signals inside and outside the CDE display heart, appear on the site of shunt, width, phase, color to determine the site of abnormal segregation, sub-flow and shunt. By multi-angle scanning, the atrioventricular and aortic infer the spatial relationship between anatomy and measurement of left and right pulmonary artery and thoracic aorta through the diaphragm Department level aorta. X ray cardiovascular imaging: use of anesthesia in patients with ketamine intravenous anesthesia plus local anesthetic lidocaine puncture site, use of non-ionic contrast agent 370mg iodine / ml contrast agent was superior dimensional or iohexol, etc., conducted by 1:8 dilution, the order of cardiac catheterization by left or right femoral artery, femoral vein catheterization, right heart catheterization were reached, the inferior vena cava, right atrium, left ventricle, pulmonary artery, pulmonary artery (or pulmonary vein) There were atrial septal defect to the left atrium by the atrial septal defect; left heart catheter retrograde through the descending aorta, ascending aorta to the left ventricle. Line pressure and oxygen saturation monitoring.Angiocardiography were performed selective right and left ventricular and aortic angiography, if necessary, by pulmonary artery wedge angiography to understand changes in pulmonary vascular bed [3].MRI: Magnetic resonance imaging with high-end GE 3.0T magnetic resonance equipment, scan the first scan plane positioning as standard, including the aortic arch above the scanning plane, below the diaphragm 3cm, all patients underwent plain and coronal scanning, research and evaluation heart, aortic arch, pulmonary artery, pulmonary vein, valve, inferior vena cava and the internal organs of the situation, the film scanner is the major axis, including left ventricular short axis, long axis horizontal and the vertical plane, to the heart of the measurement or functional analysis, all cases should dynamic enhanced MRI for angiography, blood flow to understand way, showing the vascular,Used to analyze the heart and large blood vessel connection is related to abnormal scan range of needs, including the heart and great vessels chest.Results: After surgery confirmed cases of cardiac abnormalities and a total of 285 lesions, CT angiography was found in 274 lesions, diagnosis rate of 96.5%, echocardiography (UCG) check out the 238 lesions, diagnosis rate of 83.7% , X ray diagnosis of 213 cardiovascular imaging, diagnostic rate of 79.4%; with cardiovascular disease were 132, CT cardiac imaging display 131, the accordance rate of 99.7, only a result of the moving image artifacts, resulting in missed lesions , 96 echocardiography, diagnosis rate of 74.3%, X-ray cardiovascular imaging showed 125, diagnosis rate of 93.4%; for coronary artery opening variation,Lesions found in 6 cases, CT angiography in 6 cases found lesions, diagnosis was 100%, echocardiography (UCG) Check out the lesion 0, diagnosis rate 0%, X ray angiography confirmed two cardiovascular diagnosis compliance rate of 33.3%; the diameter of the pulmonary artery, CT cardiovascular imaging and the actual width measurement error of 5%, and echocardiographic measurements and the actual width of the error of 24%, X ray cardiovascular imaging and the actual measurement error of about 16% , on the above statistics.Data analysis, it is obvious that in mind, whether CT angiography in cardiovascular malformations showed a large variation of blood vessels, the pulmonary artery with color Doppler ultrasound measurement, X ray cardiovascular imaging, compared with the obvious advantages, particularly as it relates to crown pulse variation of the show opening, its examination of the lesion was significantly higher than other methods, X ray cardiovascular imaging for the heart and great vessels in coronary artery opening variation and have a good inspection rate, used to be known as the cardiovascular examination the gold standard, but in this experiment, the inspection of their disease rate and the actual measurements were significantly lower than the error on a CT cardiovascular imaging. Conclusion: The cardiovascular examination in the three major means: echocardiography, X ray cardiovascular imaging, CT angiography were on the heart of cardiovascular malformations have a higher detection rate of cardiac abnormalities as assessed technical means, for heart valve morphology and movement, indeed loss of streaming condition, the movement of cardiac ultrasound has some advantages, but the situation for the development of pulmonary vein ectopic drainage, aortic disease, coronary conditions and collateral circulation, CT Cardiovascular imaging is significantly better than other tests, a statistically significant difference (P <0,0.1), in particular variation in the coronary artery open the display,64CT angiographic examination of coronary lesions was 100%, it should open as a variation of coronary preferred method of examination, X ray diagnosis of cardiovascular disease as the traditional gold standard, but the methods for the invasive inspection, with certain surgical risk, and the image before and after the duplication, can not multi-angle display, the kinds of inspection methods have been gradually replaced by ultrasound and CT, the only advantage is that pulmonary artery pressure measurements, echocardiography can be seen to solve most of the diagnosis of congenital heart disease, but The sound of the window because of bone artifacts and images, for the near.Bone and lung lesions showed clear, there is a certain possibility of misdiagnosis, 64-slice CT examination with high accuracy, low cost, safe and noninvasive examination of congenital heart disease as the first screening method. |
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