| 摘要: |
| 目的：分析超声心动图和CTA对迷走锁骨下动脉(aberrant subclavian artery,ASA)的术前诊断情况,评估迷走锁骨下动脉术后的随访结果。方法：回顾性分析192例经心胸外科手术证实为ASA的患儿资料。结果：192例患儿中,189例为右位主动脉弓伴迷走左锁骨下动脉(right aortic arch and aberrant left subclavian artery, RAA-ALSA),3例为左位主动脉弓伴迷走右锁骨下动脉(left aortic arch and aberrant right subclavian artery,LAA-ARSA)。132例合并其他心脏结构畸形,常见合并畸形有Kommerell憩室96例、房间隔缺损/卵圆孔未闭89例、室间隔缺损51例、左侧上腔静脉残存20例、动脉导管未闭17例。192例患儿中,超声心动图准确诊断上述ASA共124例,占64.6%；漏误诊68例,占35.4%；CTA准确诊断上述ASA共174例,占90.6%,漏误诊18例,占9.4%；在132例常见合并畸形中,超声心动图漏诊2例卵圆孔未闭；CTA诊断漏诊47例房间隔缺损/卵圆孔未闭,漏诊3例小室间隔缺损；在96例行迷走左锁骨下动脉移植或Kommerell憩室切除的术后患儿中随访发现,行迷走锁骨下动脉移植及Kommerell憩室切除的81例患儿吻合口均无明显梗阻,且14例经CTA评估气管压迫均较术前减轻。结论：超声心动图和CTA在术前诊断ASA中各有优势和不足,在术后的随访过程中可以分别评估吻合口及气管压迫的情况,因此,联合超声心动图及CTA进行多模态检查,可以更准确的诊断ASA及合并心脏畸形,同时也能更全面的评估术后恢复效果。 |
| 关键词: 超声心动图 CTA 迷走锁骨下动脉 Kommerell憩室 |
| DOI： |
| 投稿时间：2022-08-15修订日期：2022-08-28 |
| 基金项目:国家自然科学基金 (61975056), 上海市自然科学基金(19ZR1416000), 上海市科学技术委员会资助项目(20440713100) |
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| The diagnostic value and postoperative follow-up analysis of echocardiography and CTA in children with aberrant subclavian artery |
| liuyiman,zhangzhifang,shenrong,chenlijun,humenghan,chenjiangang,liqingli,zhangyuqi |
| (Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine) |
| Abstract: |
| Objective To analyze the preoperative diagnosis of aberrant subclavian artery (ASA) by echocardiography and CTA, and to evaluate the postoperative follow-up results. Methods Data of 192 childrens with ASA confirmed by cardiothoracic surgery were retrospectively analyzed. Results In 192 childrens, 189 cases were right aortic arch with aberrant left subclavian artery (RAA-ALCA). 3 cases were left aortic arch with aberrant right subclavian artery (LAA-ARLA). 132 cases combine with other common cardiac structural malformations. The common malformations included 96 cases of Kommerell diverticulum, 89 cases of atrial septal defect/patent foramen ovale, 51 cases of ventricular septal defect,20 cases of left superior vena cava remaining, 17 cases of patent ductus arteriosus. In 192 cases, echocardiography accurately diagnosed ASA in 124 cases (64.6%); 68 cases (35.4%) were misdiagnosed. A total of 174 cases (90.6%) were accurately diagnosed by CTA, and 18 cases (9.4%) were missed and misdiagnosed. In 132 cases complicated with other cardiac structural malformations, Echocardiography missed diagnosis of patent foramen ovale in 2 cases, 47 cases of atrial septal defect/patent foramen ovale and small ventricular septal defect were missed by CTA diagnosis. In the follow-up of 96 children who underwent vagal left subclavian artery transplantation or Kommerell diverticulectomy, 81 children who underwent vagal subclavian artery transplantation and Kommerell diverticulectomy had no obvious anastomotic obstruction, and 14 patients underwent CTA. Evaluated tracheal compression was less than preoperative.Conclusions Echocardiography and CTA in the preoperative diagnosis of ASA each have advantages and disadvantages, can respectively in the process of postoperative follow-up evaluation anastomotic and airway pressure situation, therefore, the joint multimodal inspections on echocardiography and CTA, can be more accurate diagnosis of ASA and merge heart abnormalities, as well as a more comprehensive evaluation of postoperative recovery effect. |
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