| 摘要: |
| 目的 分析302例心上型完全性和部分性肺静脉异位引流(TAPVC和PAPVC)的彩色多普勒超声心动图图像特点,探讨其超声诊断价值及误诊与漏诊原因。方法 回顾性研究204例完全性和98例部分性心上型肺静脉异位引流患者的彩色多普勒超声图像特征,与CT或手术对照,分析漏、误诊原因与鉴别要点。结果(1)204例心上型TAPVC的超声心动图诊断准确率为100.0%。引流部位方面,193例汇入头臂静脉；11例直接开口于右上腔静脉。引流支数方面,202例表现完整的4支肺静脉；仅2例显示3支肺静脉。主要合并的畸形有房间隔缺损165例(80.9%)、卵圆孔未闭34例(16.7%)等。(2)98例心上型PAPVC的超声心动图诊断符合74例、误诊20例(6例超声分型与外科手术不符、9例引流支数误判及5例手术正常)、漏诊4例(3例超声仅提示房缺、1例孤立性肺静脉异位引流),诊断准确率、误诊率、漏诊率分别为75.5%、20.4%和4.1%。引流部位方面,60例引流入头臂静脉、37例汇入右上腔静脉、1例经奇静脉汇入上腔静脉。引流支数方面,单支71例、二支21例及三支6例。合并的常见畸形有房间隔缺损67例(68.4%)、卵圆孔未闭15例(15.3%)等。结论 超声诊断部分性肺静脉异位引流的准确性弱于完全性,通过有意识加强灵活应用胸骨旁、剑突下、右锁骨上窝上腔静脉长轴等非标准切面,全面扫差异常血管走形,关注异位引流的部位、汇入支数及合并畸形,注重伪像及正常或异常心内结构的鉴别诊断,有助于降低心上型肺静脉异位引流的漏误诊率。 |
| 关键词: 心上型肺静脉异位引流 完全性,部分性 彩色多普勒超声心动图 漏误诊 |
| DOI： |
| 投稿时间：2019-07-07修订日期：2019-07-07 |
| 基金项目: |
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| To investigate the ultrasound diagnosis and misdiagnosed causes of 302 cases ofsupracardiac anomalous pulmonary venous connection |
| zhao |
| (Department of Ultrasound of the first affiliated hospital of AFMU) |
| Abstract: |
| Objective To investigate the clinical value of color doppler echocardiography in the diagnosis of 302 cases of supraventricular total and partial pulmonary venous connection (TAPVC and PAPVC), and to analyze the causes of misdiagnosis and missed diagnosis. Methods This study retrospectively analyzed the color doppler ultrasonography of 204 cases with TAPVC and 98 cases with PAPVC. Compared with CT or surgery, the causes and identification points of misdiagnosis were analyzed. Results (1)The accuracy of ultrasound echocardiographic diagnosis of the supraventricular TAPVC 204 cases was 100.0%. In terms of drainage site, 193 cases were transferred to the brachiocephalic vein; 11 cases were directly open to the right superior vena cava. In terms of drainage count, 202 patients showed complete pulmonary veins; only 2 patients showed 3 pulmonary veins. It combined with malformations, such as 165 cases (80.9%) of atrial septal defect, 34 cases (16.7%) of patent foramen ovale.(2) The ultrasound echocardiographic diagnosis of the supraventricular PAPVC 98 cases can clearly diagnosed 74 cases, misdiagnosed 20 cases(6 cases of misclassification of ultrasound classification and 9 cases of misdiagnosis of drainage count, 5 cases of normal operation), missed diagnosis 4 cases(3 cases of ultrasound only indicated atrial septal defect and 1 case of isolated anomalous pulmonary venous venous connection). The diagnostic accuracy rate, misdiagnosis rate and missed diagnosis rate were respectively 75.5%, 15.3% and 9.2%. In terms of drainage site, 60 cases were introduced into the brachiocephalic vein, 37 cases were directly transferred into the right superior vena cava, and 1 case was transferred into the superior vena cava via azymatic vein. In terms of drainage count, 71 cases were single, 21 cases were two, and 6 cases were three. It combined with malformations, such as 67 cases (68.4%) of atrial septal defect, 15 cases (15.3%) of patent foramen ovale. Conclusion The accuracy of ultrasound in the diagnosis of PAPVC is weaker than TAPVC. By consciously enhancing the flexible application of non-standard sections such as the parasternal, xiphoid, right supraclavicular superior vena cava long axis, we can comprehensively scan abnormal blood vessels, and pay attention to the location of ectopic drainage, the number of inflows, and the combined malformations. We need to comprehensively sweep abnormal blood vessels, and pay attention to the location of ectopic drainage, the number of sinks and the combined deformity. Then we value artifacts and differential diagnosis of normal or abnormal intracardiac structures. These aspects help to reduce the rate of misdiagnosis of supraventricular pulmonary venous drainage. |
| Key words: Supracardiac anomalous pulmonary venous connection Total and Partial Color doppler echocardiography Misdiagnosis |
