完全性肺静脉异位引流超声心动图诊断价值及局限性  

The values and limitation of echocardiography in the diagnosis of total anomalous pulmonary venous connection

作　　者：李静雅[1] 王芳韵[1] 金兰中[1] 马桂琴[1] 郑淋[1] 卫海燕[1] 张鑫[1] 张晓琳[1] 

机构地区：[1]首都医科大学附属北京儿童医院心脏中心超声心动图室,100045

出　　处：《中华医学超声杂志（电子版）》2013年第2期129-133,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨超声心动图对完全性肺静脉异位引流(TAPVC)的诊断价值及局限性。方法回顾性分析2009年6月至2011年12月在北京儿童医院经胸超声心动图检查及手术证实为TAPVC患儿44例,分析其超声心动图直接征象和间接征象,根据肺静脉回流途径的特点总结TAPVC亚型及回流中存在的变异,并与术中所见相比较。结果 TAPVC患儿超声心动图共同征象:直接征象为左心房偏小,左心房内无肺静脉入口,左心房后方可见由4支肺静脉汇合形成的共同肺静脉干;间接征象为右心房、右心室重度增大,彩色多普勒血流成像示心房水平完全的右向左分流信号。44例TAPVC患儿中心上型28例(63.6%,28/44)、心内型12例(27.3%,12/44)、心下型1例(2.3%,1/44)、混合型3例(6.8%,3/44)。心上型可根据回流途径分为3种亚型,分别为左行(26例)、双行(1例)、直行(1例)亚型;心内型可分为2种亚型,分别为回流冠状静脉窦(10例)、回流右心房(2例)亚型;心下型(1例)无亚型;混合型走行较复杂,2种亚型均为3+1型(3例)。肺静脉回流途径狭窄、肺静脉分支异常为较常见的变异。超声诊断回流部位准确率达97.7%(43/44),回流途径准确率达93.2%(41/44)。结论超声心动图是诊断TAPVC最为简便、快捷的方法。诊断准确率高,且可明确分型。肺静脉回流途径的走行及变异为超声心动图诊断TAPVC难点。Objective To assess the value and limitation of echocardiography in the diagnosis of total anomalous pulmonary venous connection(TAPVC).Methods Forty-four cases of pediatric TAPVC patients in Beijing Children's Hospital from June 2009 to December 2011 were retrospectively analyzed.The echocardiography characteristics including direct and indirect signs,described the subtype and pulmonary vein anomaly according to the characteristics of drainage path were ummarized and compared with surgical treatment.Results All the 44 patients with confirmed TAPVC were included in this study.The common clinical presentations of the patients included:the direct signs were the smaller left atrium,no entrance of pulmonary vein in the left atrium and four veins forming a common confluence just beside it;the indirect signs included enlargement of right atrium and right ventricle.Color Doppler flow imaging showed total interatrial right to left shunt.The specific types of TAPVC were as followed:supra-cardiac(63.6%,28/44),cardiac(27.3%,12/44),infra-cardiac(2.3%,1/44)and mixed(6.8%,3/44).The supra-cardiac type were further divided into 3 subtypes according to the drainage path:right and left veins forming a common confluence,then draining into vertical and innominate veins(26 cases);right and left pulmonary veins separately draining into superior vena cava(1 case);common confluence of pulmonary vein draining into superior vena cava through a vertical vein(1 case).The cardiac type were further divided into 2 subtypes:coronary sinus(10 cases),right atrium(2 cases).Infra-cardiac type had no subtype(1 case).Mixed type was more complex,both of the two subtypes were '3+1'(3 cases).Drainage path stenosis and pulmonary vein anomaly were common variations.The diagnostic accuracy of drainage position and path in the study were 97.7%(43/44) and 93.2%(41/44).Conclusions Echocardiography is one of the simplest and most efficient modality for the diagnosis and typing of TAPVC,with high diagnostic accuracy.The diagnosis of drainage path and variation

关 键 词：超声心动描记术 心脏缺损 先天性 儿童 诊断 

分 类 号：R725.4[医药卫生—儿科]