| Objective:To document the frequency and anatomical features of the left atrial diverticulum on adult cadaver hearts and dual source CT images, providing anatomic reference for imageology diagnosis and clinical treatment of heart.Methods:①The materials were obtained from133formalin fixed adult cadaveric hearts without significant lesions, and the gender and age were not recorded. Remove the pericardium, cut the trachea, esophagus and burdensome objects and the main vessels connected to the heart. Make the appearance of hearts clean and tidy, and the surface maker was well displayed, in order to make sure the position of heart and provide convenience for following work. Remove the connective tissue around the left atrium, open the left atrium and wash the content of it, observe it carefully and evaluate whether diverticulum exists. If it has a diverticulum, then observe the number, location and shape of the diverticulum, and measure its size, depth,the thickness of the diverticulum and the left atrium, and the minimum distance between the diverticulum and its adjacent pulmonary vein. At the same time,(depth/maximum diameter of mouth) was calculated. If (depth/maximum diameter of mouth) was<2, the left atrium diverticulum was cystiform. Otherwise it was tubiform.②From June2011to september2011, in Tianjin chest hospital,1070patients (577males,493females, aged between29and86years, mean age56.68±9.90) at random who were questionably ill with atypical dyspnea, chest pain, and acute coronary syndrome were performed ECG gating for DSCT of coronary angiography. Siemens Syngo work station was used to evaluate the image features of left atrium, finding the diverticulum of the left atrium, document the frequency and variations in number(single, multiple) and anatomical shape (cystiform, tubiform) of the left atrium diverticulum. The cervix width, body length of left atrium diverticulum was measured on original transverse image or MPR image. At the same time (body length/cervix width) was calculated. If (body length/cervix width) was<2, the left atrium diverticulum was cystiform. Otherwise it was tubiform. The minimum distance between the diverticulum and its adjacent pulmonary vein was measured.Results:①37(27.8%) of133adult cadaver hearts had40diverticula of left atrium (3hearts had two). Thirty-three diverticula (82.5%) were located at right anterosuperior wall, four diverticula (10.0%) were located at left anterosuperior wall, three diverticula (7.5%) were located at right posterosuperior wall.91.9%(34/37) of them were single, the rest (3/37) were multiple. According to the shape of opening form of the diverticulum, two types were observed:small recess (75%,30/40) and broad-based diverticulum(25%,10/40). This classification is based on morphologic appearance, and is not a preexisting scheme. Macroscopically, the endocardial surface of the diverticulum shared the same aspects as that of the tissue around it and was continuous with the body of the left atrium. In some cases, the trabeculated myocardium could be observed in the diverticulum. The maximum diameter of mouth of the left atrium diverticulum was8.87±4.93mm (range from2.72to24.92mm). The minimum diameter of mouth of the left atrium diverticulum was5.63±2.79mm (range from2.06to11.76mm). The depth of the diverticulum was4.03±1.27mm (range from2.36to7.46mm). The range of (depth/maximum diameter of mouth) was from0.20to1.57. The median of it was0.55±0.27. The rate of all the left atrium diverticulua was<2, so the forty diverticulua were all cystiform. The thickness of the diverticulum’s wall was0.94±0.33mm (range from0.48to1.64mm), the thickness of the normal body of the left atrium was1.37±0.37mm (range from0.82to2.22). There was a significant difference between them, the diverticulum’s wall was thinner than the normal body of the left atrium’s (P<0.001). The minimum distance between the lateral border of diverticulum and its adjacent pulmonary vein’s lateral border was (13.22±2.97) mm (range from6.12to17.12mm).②There were193patients (110males,83females) with left atrium diverticulum in1070consecutive patients (577males,493females) who underwent DSCT of coronary angiography. The presence probability of left atrium diverticulum was18.0%, male of it was19.1%(110/577), female was.16.8%(83/493). The probability of diverticulum in less than60-year-old group was19.6%(135/690), more than or equal to60-year-old group of it was15.3%(58/380). There was no difference on gender and age (P>0.05).208left atrium diverticula were found in193patients (fifteen patients had two).196diverticula (94.2%) were located at right anterosuperior wall, eleven diverticula (5.3%) were located at left anterosuperior wall, one diverticula was located at right posterosuperior wall.92.2%(178/193) of them were single, the rest (15/193) were multiple. The cervix width of left atrium diverticulum was6.28±3.71mm (range from1.11to18.32mm). The body length was6.03±2.17mm (range from1.8to9.4mm). The range of (body length/cervix width) was from0.31to5.35. The median of it was1.36.78.8%(164/208) left atrium diverticula’s (body length/cervix width) was<2, which were cystiform, the rest (44/208) were tubiform. The minimum distance between the lateral border of diverticulum and its adjacent pulmonary vein’s lateral border was (12.76±4.00) mm (range from4.77to25.35mm). The distance in the cystiform group was12.47±3.67mm, which was shorter than that in tubiform group (13.80±4.24mm). There was a significant difference between the two groups (P<0.05), but have no difference on gender and age (P>0.05).Conclusion:①Left atrium diverticulum was a kind of objective existence of the heart anatomical variation. It was comparatively commonly found in the adult cadaver hearts and DSCT images, which should arouse the attention of radiologist and electro physiologists to this particular anatomical variation of left atrium wall, the study could provide anatomy details of left atrium diverticulum to help to finish heart and chest surgery successfully.②DSCT combines several image post-processing technology can demonstrate and evaluate the diverticulum of left atrium, which can provide comprehensive intuitionistic imaging guidance for the clinic and provide valuable information for the electric physiology intervention operation plans. It can help to prepare for the operation, improve the success rate. |
PDF Full Text Request