左心耳解剖结构和影像学特征.pdfVIP

2015年12月第35卷第12期 中国实用内科杂志 979 专题笔谈·左心耳封堵临床实践 左心耳解剖结构和影像学特征 1 2 林逸贤 ，王 静 DOI：10.7504/nk2015110201 中图分类号：R331 文献标识码：A 摘要 ：左心耳 (LAA) 为延续于左心房的一盲端结构，具有特殊的胚胎起源、解剖结构和生理功能。在心血管疾病中， LAA 是血栓形成的主要部位，增大脑卒中风险 ；而近来研究发现 LAA 也是不容忽视的房性心律失常的触发点。因 此，早期发现 LAA 结构和功能异常对疾病的治疗和预后具有重要的意义。影像学评估 LAA 结构功能和血流动力 学改变具有明显的优势。目前，经食管超声心动图 (TEE) 是评估 LAA 的首选方法，能清晰显示 LAA 的形态结构 和血栓，尤其是三维超声可立体直观地从任意角度和平面观察 LAA，较二维超声提供更多的信息。心脏多排螺旋 CT(MDCT) 和心脏核磁共振 (CMR) 亦可无创准确地显示 LAA 的解剖细节，提供较高分辨率的图像，为临床诊断和 治疗提供依据。 关键词 ：左心耳 ；超声心动图 ；心脏多排螺旋 CT ；心脏核磁共振 Anatomic structure and imaging features of left atrial appendage. * * LAM Yat-Yin , WANG Jing. Hong Kong Society of Congenital Structural Heart Disease, Hong Kong, China Corresponding author: LAM Yat-Yin, E-mail: yylam@ Abstract: Left atrial appendage (LAA) is a finger-like extension from the main body of the left atrium with unique embryonic origin, anatomic structure and physiological function. Nearly 90 percent of the thrombi responsible for stroke in non-valvular atrial fibrillation were formed in LAA and occlusion of the LAA orifice has beem proven an effective alternative to warfarin for stroke prevention in these patients. Therefore, it is clinically important to understand LAA anatomy by various cardiac imaging modalities. At present, the widely recommended imaging option for visualizing LAA is transesophageal echocardiography (TEE), particularly three-dimensional echocardiography which allows a more complete and comprehensive evaluation of LAA with a multiplane approach by overcoming some of the limitations associated with