| 摘要: |
| 目的: 探讨经胸超声心动图(TTE)在肺动脉异常起源于升主动脉（AOPA）的术前诊断价值、漏误诊原因及术后随访，旨在提高诊断准确率，减少漏误诊。
方法: 回顾性分析经CT血管造影（CTA）或手术证实的17例AOPA患者的术前经胸超声心动图结果及术后随访情况。
结果: 17例AOPA患者中，右肺动脉异常起源于升主动脉占76.47%( 13/17)；左肺动脉异常起源于升主动脉占23.53%( 4/17)；近端型占82.3%( 14/17)，伴有其他心脏畸形者占 41.18%( 7/ 17)；漏诊2例（1例为AOPA合并主肺动脉间隔缺损，1例为AOPA合并法洛四联症）。手术证实，超声心动图诊断AOPA的准确率为88.23%( 15/ 17) 。15例行外科手术治疗，效果良好，术后超声心动图评估显示肺动脉吻合口通畅及肺动脉分支无明显狭窄，肺动脉压力明显下降。
结论：AOPA合并复杂心内畸形易漏诊，经胸超声心动图能够清楚显示其他心内畸形和血流动力学变化，在AOPA术前诊断及术后随访中起重要作用。故经胸超声心动图是诊断AOPA的首选方法。 |
| 关键词: 超声心动图 肺动脉异常起源 先天性心脏病 外科手术 |
| DOI： |
| 投稿时间：2019-02-02修订日期：2019-02-02 |
| 基金项目: |
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| Application of transthoracic echocardiography in diagnosis and misdiagnosis of anomalous origin of pulmonary artery from ascending aorta |
| zhuxiaoli,wangzheng |
| () |
| Abstract: |
| Objective: To investigate the value of transthoracic echocardiography (TTE) in preoperative diagnosis, the cause of misdiagnosis and postoperative follow-up of pulmonary artery abnormality originating from the ascending aorta (AOPA).
Methods: The results of preoperative transthoracic echocardiography and postoperative follow-up of 17 patients with AOPA confirmed by CTA or surgery were retrospectively analyzed.
Results: Among the 17 patients with AOPA, the right and the left pulmonary artery originated from ascending aorta were separately 76.47% (13/17) and 23.53% (4/17); The proximal type accounted for 82.3% (14/17), and other heart malformations accounted for 41.18% (7/17); 2 cases were missed (one was AOPA with primary pulmonary artery septal defect, the other was AOPA with Fallot tetralogy).
The accuracy of ultrasound diagnosis of AOPA was 88.23% (15/17), confirmed by surgery. 15 cases of all patients underwent surgical treatment, and showed favourable effects. Echocardiography was used to evaluate the smoothness of the pulmonary anastomosis postoperatively, and exhibited that the pulmonary artery branch show no obvious stenosis and the pulmonary artery pressure was significantly decreased.
Conclusion: The diagnosis of AOPA combined with complicated intracardiac malformation is more easily missed. The other intracardiac malformations and hemodynamic changes are clearly showed by echocardiography, which plays an important role in preoperative diagnosis and postoperative follow-up of AOPA. Transthoracic echocardiography is a non-invasive and accurate method for diagnosing AOPA. |
| Key words: echocardiography anomalous origin of pulmonary artery congenital heart disease surgical operation |
