Three Dimensional CT Of Heart Study On The Apical Anatomy And Clinical Application

Objective: To study the apical anatomy of heart, diagnose the congenital heart diseases with three-dimensional CT (3DCT), ascertain its effect and advantage in the follow-up examination of transplanted heart, and finally evaluate the application value of 3DCT.Methods: Multi-detector computed tomography scanner (Light Speed VCT, GE, USA; 64-MSCT) with the Advantage Workstation 4.2 was used, as well as nonionic contrast medium ( Omnipaque 320 mgI/m, shanghai, GE in China ), normal saline and double-tube high-pressure injector (Stellant, Medred Co., USA). 3D images were obtained with volume rendering (VR), maximum density projection (MIP), multiplayer reconstruction (MPR) , curved shape reform(CPR) and so on.Twelve cases heart specimens were observed and measured, and the thinnest and thickest measurements of the apical part was obtained. With 3DCT, 69 subjects' hearts were shown and measured, and the thinnest, thickest measurements of apical part was obtained, as well as the distance between the thinnest point and left anterior descending artery. Eighty-six patients of congenital heart diseases were diagnosed with 3DCT, their imaging characteristics were analysed.Follow-up examination of 11 heart transplant recipients were performed with 3DCT. The morphology of the heart, coronary artery and their lesions were observed. Finally, the clinical value of 3DCT was evaluated.Results: There is an apical thin part of left ventricle on the heart specimens, the measurement is 1.74 mm±0.32 mm, correspondingly the thickest measurement of the left ventricular is 13.07 mm±1.48 mm. 3DCT can clearly show the apical thinning, and the measurement is 1.27 mm±0.31 mm, correspondingly the thickest measurement of the left ventricular is 12.02±1.66mm, the distance between the thinnest point and left anterior descending artery is 13.7 mm±3.78 mm.Eighty-six cases with congenital heart disease (CHD) were diagnosed with 3DCT, of which 41 cases were TOF, 15 PDA, 15. CAF, 11 VSD, 1 ASD and 3 VSD with ASD. Diagnosed results of 75 cases with CHD were accorded with the surgery or coronary angiography, the accuracy is 97.3%.Eleven heart transplant recipients were successfully examined and 3D-images were obtained with satisfactory quality. 3DCT can clearly and directly show the anatomic structure of the transplanted heart and coronary artery, as well as their lesions. In the total 11 cases, 10 cases have been found abnormal ( the stenosis of the coronary artery in 6 and the enlargement of the right ventricular in 4), 1 with no obvious abnormality.Conclusion: Chinese people have the apical thinning of heart, which were shown by anatomy and 3DCT. 3DCT has a high accuracy in diagnosing the CHD. It can clearly and directly show the coronary artery, structure of heart and thier lesions with the advantage of high spacial resolution and clearly the surrounding structures. 3DCT can provide the detail anatomy basis for the clinical surgery and will become a significant method of the heart disease screening.