| 摘要: |
| 【摘要】 目的 探讨主肺动脉间隔缺损的超声心动图特点，以期提高无创超声心动图对主肺动脉间隔缺损的检出率及诊断准确率。 方法 回顾性分析北京安贞医院2002-2017年经心导管及手术结果证实的主肺动脉间隔缺损患者的超声心动图特点，包括主肺动脉间隔缺损的分型、部位、大小、房室大小、分流情况，合并其他心脏畸形情况。 结果 1.经心导管及手术证实主肺动脉间隔缺损49例，术前超声准确诊断主肺动脉间隔缺损 45例，漏诊 4例，漏诊率为8.2%。2.I型 11例（22.4% ），II型 24例（49.0%），III 型14例（28.6%）。超声心动图诊断的45例分型均与经心导管及手术病理结果相符。单纯主肺动脉间隔缺损 4例（8.2%），合并其他心脏畸形 45例（91.8%），常合并畸形为室间隔缺损。3.49例主肺动脉间隔缺损的超声心动图特点:（1）二维超声表现：直接征象：主肺动脉间隔连续性中断，缺损范围约5mm-50mm。继发改变：左心系统增大 22例（44.9%），右心系统增大 4例（8.2%），全心扩大（左心为著） 21例（42.9%），右室壁增厚 4例(8.2%）。主动脉、肺动脉内径增宽，以肺动脉内径增宽为著。(2)彩色多普勒超声表现：左向右分流12例（26.7%），双向分流 25例（55.6%），右向左分流 8例（17.7%）。轻度肺动脉高压 3例（6.1%），中度肺动脉高压 10例（20.4%），重度肺动脉高压 36例（73.5%）。4.超声诊断的45例主肺动脉间隔缺损患者中出现右向左分流（艾森曼格综合征）的中位年龄为2.54岁。 结论 超声检查是一种诊断主肺动脉间隔缺损的有效检查方法。但存在漏诊，当存在心内分流，但与肺动脉高压程度不匹配时，应考虑主肺动脉间隔缺损的可能。对主肺动脉间隔缺损的术前详细评估有利于临床治疗策略的制定。 |
| 关键词: 主肺动脉间隔缺损 超声心动图检查 诊断 |
| DOI： |
| 投稿时间：2018-10-17修订日期：2018-10-17 |
| 基金项目:深圳市三名工程资助(SZSM201612027)；北京市卫生系统高层次卫生技术人才培养计划(2015-3-049)；扬帆计划临床技术创新项目(XMLX201604)；首都卫生发展科研专项重点攻关项目(2016-1-2061) |
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| Diagnosis value of echocardiography in aortopulmonary septal defect |
| luo chang rui,he yi hua |
| () |
| Abstract: |
| 【Abstract】: Objective To investigate the characteristics of echocardiography of aortopulmonary septal defect (APSD) in order to improve the detection rate and diagnostic accuracy of noninvasive echocardiography for APSD. Methods The retrospective analysis of the characteristics of echocardiography APSD of Beijing Anzhen Hospital from
2002 to 2017 were confirmed by cardiac catheterization and operation results, it includes the type, location, size, shunt,
merging other cardiac malformation of APSD. Results 1. 49 APSD was confirmed by cardiac catheterization and surgery, 45 cases were diagnosed by preoperative echocardiography, and 4 cases were missed, and the missed diagnosis rate was 8.2%. 2.Type I were 11 cases (22.4%), type II were 24 cases (49%), type III were14 cases (28.6%). All the 45 cases of echocardiography were consistent with the pathologic results. There were 4 cases (8.2%) of pure APSD (8.2%), and 45 cases (91.8%) were combined of other cardiac malformations, such as VSD. 3. Two-dimensional echocardiography: direct sign: APSD continuity interruption( 5mm-50mm). Second changes: the left heart system enlarged were 22 cases (44.9%), the right heart system enlarged were 4 cases (8.2%), the whole heart expanded (the left heart was) were 21 cases (42.9%), and the right ventricular wall thickened were 4 cases (8.2%). The inner diameter of the aorta and pulmonary artery was widened, especially the pulmonary artery. Color doppler flow imaging: left to right shunt :12 cases (26.7%), bi-directional shunt:25 cases (55.6%), and right to left shunt: 8 cases (17.7%). There were 3 cases of mild pulmonary hypertension (6.1%), 10 cases of moderate pulmonary hypertension (20.4%), and 36 cases of severe pulmonary hypertension (73.5%). 4. In the 45 cases of APSD diagnosed by ultrasonography, the median age of right-left shunt (Eisenmenger Syndrome) was 2.54 years. Conclusion Ultrasonography is an effective method for diagnosis of APSD. However, there is a missed diagnosis, and when there is intracardiac shunt, the possibility of APSD should be considered when there is no matching with pulmonary hypertension. The preoperative detailed evaluation of APSD is helpful to the formulation of clinical treatment strategy. |
| Key words: Aortopulmonary septal defect Echocardiography Diagnosis |
