Abstract： Objective To evaluate the diagnostic accuracy for the the assessment of coronary artery stenosesusing 64-multislice spiral computed tomography （64-MSCT） scanner compared with selective coronary angiography（SCA）. Methods 64-MSCT and SCA were both performed in 93 patients with 74 males and 19 females at mean age of （58.2±8.5） years in West China Hospital between April 2004 and December 2010. The cardiacrhythm of all the patients was stably sinus. Patients with initial heart rates≥90 time/min were received treatments of β-blockers. All available coronary segments（internal diameter ≥ 2.0 mm）were included in the evaluation. Lesions with ≥ 50％ luminalnarrowing were considered as significant stenosis. According to the image detail of segments and existance of artfacts,the image quality was randed Ⅰ to Ⅳ ,with rank Ⅰ to Ⅲ meeting demands of image evaluation. Evaluations had been done concerning the 64-MSCT scanner for detecting the stenosis of the variant branches or segments of the coronary artery. Results 64-MSCTprovided a full image correspondence(100%,1 238/1 238)of all the segments clearly displayed in the SCA. All of the coronary segments involved （n=1 238） met the quality demands of being evaluated as rankⅠ to Ⅲ. Considering SCA as the golden standard， overall sensitivity for classifying stenosis using 64-MSCT scannerwas 88.8%（427/481）， specificity was 91.7%（694/757）， positive predictive value was 87.1%（427/490），and negative predictive value was 92.8%（ 694/748）.While the stenosis diagnostic accuracy of proximal left circumflexbranch and the first obtuse marginal branch of left coronay artery is lower than other branches： the sensitivity of the proximal left circumflex branch was 68.3%（41/60），specificity was 60.6%（20/33），positive predictive value was 75.9%（41/54），negative predictive value was 51.3%（20/39）；the sensitivity of the first obtuse marginalbranch was 58.8%（10/17），specificity was 93.5%（58/62），positive predictive value was 71.4%（10/14），negative predictive value was 89.2%（58/65）. Arterial wall calcification and false image of cardiac movements were the maininfluence factors for accuracy of the the assessment of coronary artery stenosis with 64-MSCT scanner. Conclusion 64-MSCT scanner provids a high diagnostic accuracy in assessing stenosis of the coronary artery. The anatomical location and luminal area of coronary artery were the main influence factors of diagnostic accuracy. Thus the diagnostic accuracy in proximal left circumflex branch and the first obtuse marginal branch of left coronary artery was lower than other coronarysegments.
Abstract： Objective To explore a new videoassisted thoracoscopic surgical treatment for lone atrial fibrillation, in order to seek better efficacy, reduce invasiveness, and devise an easiertooperate surgical treatment for atrial fibrillation. Methods In June 2011, 3 women aged 40 years, 60 years, and 66 years with lone atrial fibrillation were treated in the Cardiovascular Surgery Department of West China Hospital. The patients underwent a videoassisted thoracoscopic “Box Lesion” bipolar radiofrequency atrial fibrillation therapy (bilateral pulmonary vein + left atrial posterior wall isolation), including three 5 to 10 mm small incisions on each side of the chest wall. The complications and sinus rhythm maintenance of the patients were observed. Results The operative times were 140 min, 170 min, and 155 min. The three patients were in sinus rhythm immediately after the surgery. Mean blood loss was approximately 80 ml, mean intensive care unit (ICU) stay was 1 day, and average hospital stay was 7 days. No deaths and serious complications occurred. The three patients were still in sinus rhythm one week and one month after the operation, as measured by electrocardiogram. Conclusion Box Lesion bipolar radiofrequency treatment for atrial fibrillation therapy shows fast postoperative recovery. It is a promising procedure in atrial fibrillation treatment and is worthy of further study.