【摘要】 目的 房间隔穿刺是进行心房颤动（房颤）等左房相关心律失常消融的关键步骤。通过左房CT评估卵圆窝解剖位置、角度及与冠状静脉窦高度，指导X线下房间隔穿刺。方法 纳入2019年1月至2020年6月于清华大学第一附属医院北京华信医院行房颤消融患者，并收集一般临床资料。对患者行左房CT检查，利用多平面重组（MPR）技术重建冠状面及矢状面，定位卵圆窝穿刺点及穿刺高度与角度。进行卵圆窝角度相关性分析。结果 收集房颤消融并完善左房CT患者86例，平均年龄为（67±9）岁，其中女性占37.2%，持续性心房颤动患者占25.6%。卵圆窝与竖直线的角度为（57.3±8.5）°，计算穿刺时RAO角度（32.7±8.5）°。预计穿刺点距心大静脉最低点的竖直距离（28.4±7.4）mm；预计穿刺点与冠状窦开口竖直距离（19.8±5.9）mm。单个椎体高度为（23.9±2.1）mm。预计穿刺点距冠状静脉最低点约（1.2±0.3）个椎体，距冠状窦开口约（0.8±0.3）个椎体。按照CT指导的房间隔穿刺方法，所有患者均成功实施房间隔穿刺，且无并发症发生。未发现卵圆窝角度与左房、右房前后径、年龄、身高、体重及房颤病程具有相关性。结论 本研究完整提供以左房CT精准定位卵圆窝及穿刺角度，辅助X线房间隔穿刺方法，提高穿刺效率及安全性，降低并发症风险，为理解房间隔穿刺提供解剖支持。更多还原

【Abstract】 Objective Atrial septal puncture is a key step in the ablation of atrial fibrillation and other arrhythmia related to the left atrium. The left atrium CT was used to assess the anatomical position, angle and height of the fossa ovale and the height of the coronary sinus, and guide the atrial septal puncture under X-ray. Methods The patients who underwent atrial fibrillation ablation in Beijing Huaxin Hospital of the First Affiliated Hospital of Tsinghua University from January 2019 to June 2020 were enrolled, and general clinical data were collected. CT scan of the left atrium was performed, and the coronal and sagittal planes were reconstructed using the multi-planar reconstruction(MPR) technique to locate the puncture point and puncture height and angle of the fossa ovale. Carry out the correlation analysis of fossa ovale angle. Results A total of 86 patients with atrial fibrillation ablated and perfected left atrium CT were collected, with an average age of(67±9) years old, of which 37.2% were women, and 25.6% were patients with persistent atrial fibrillation. The angle between the fossa ovale and the vertical line is(57.3±8.5)°, and the RAO angle during puncture is calculated as(32.7±8.5)°. The vertical distance between the puncture point and the lowest point of the great cardiac vein is(28.4±7.4) mm; the vertical distance between the puncture point and the coronary sinus opening is(19.8±5.9) mm. The height of a single vertebral body is(23.9±2.1)mm. It is estimated that the puncture point is about(1.2±0.3) vertebral bodies from the lowest point of the coronary vein and about(0.8±0.3) vertebral bodies from the opening of the coronary sinus. According to the atrial septal puncture method guided by CT, all patients successfully performed atrial septal puncture without complications.No correlation was found between the angle of the fossa ovale and the anteroposterior diameter of the left and right atrium, age, height, weight and the course of atrial fibrillation. Conclusion This study provides a complete set of left atrial CT to accurately locate the fossa ovale and the puncture angle, assist X-ray atrial septal puncture methods, improve puncture efficiency and safety, reduce the risk of complications, and provide anatomical support for understanding atrial septal puncture.更多还原