超声心动图诊断小儿完全型肺静脉异位引流  

Assessment of the characteristics of echocardiography in pediatric patients with total anomalous pulmonary venous connection

作　　者：蒋国平[1] 叶菁菁[1] 何瑾[1] 赵镭[1] 彭学慧[1] 何彧[1] 杨秀珍[1] 

机构地区：[1]浙江大学医学院附属儿童医院,浙江杭州310003

出　　处：《浙江大学学报（医学版）》2006年第4期440-443,共4页Journal of Zhejiang University(Medical Sciences)

摘　　要：目的:探讨超声心动图诊断完全型肺静脉异位引流(TAPVC)的方法。方法:超声从胸骨上、胸骨旁、剑突下、心尖多个切面,观察肺静脉异位引流的途径,右房、右室的扩大程度,房间隔缺损引流方向及上下腔静脉是否扩张等,并与手术结果相对照。结果:手术证实的28例TAPVC患儿中26例超声诊断为TAPVC,1例超声诊断为部分型肺静脉异位引流,另1例诊断为三房心和TAPVC可能。超声检查结果与手术符合率为92.86%。28例TAPVC患儿中心上型17例,心内型11例。所有患儿的右房右室扩大,房间隔缺损右向左分流。心内型TAPVC中肺静脉干或4支肺静脉直接入右房或经冠状静脉窦入右房。心上型TAPVC经垂直静脉-左无名静脉-右上腔静脉入右房。结论:超声在胸骨上及剑突下多个切面探查可提高小儿TAPVC的诊断准确性。4支肺静脉各自入右房的TAPVC需与部分型肺静脉异位引流和三房心鉴别。Objective： To assess the accuracy of echocardiography in diagnosis of total anomalous pulmonary venous connection （TAPVC）. Methods： A combination of suprasternal, parasternal, subcostal and apical views were employed to diagnose TAPVC and to trace the course of the anomalous pulmonary venous connection, the direction of the inter-atrial shunt, enlargement of right atrium （RA） and right ventricle（RV）,superior and inferior vena cava. All pediatric patients underwent surgical repair,The results of echocardiography were compared with surgical findings. Results： A total of 28 consecutive pediatric patients with suspected TAPVC were included in this study. The TAPVC diagnosis was confirmed in 26 cases after surgery, partial anomalous pulmonary venous connection （PAPVC） in one case,and Cor Triatriatum and possible TAPVC in another. The diagnostic accuracy of TAPVC by echocardiography in the study was 92. 86%. There were 17 supracardiac TAPVC, 11 intracardiac TAPVC. In all patients, enlargement of the RA and RV, inter-atrial right-to-left shunt via atrial septal defects were documented in parasternal and subcostal views. Common pulmonary vein or four pulmonary vein direct to RA or via coronary sinus to RA were the draining sites of intracardiac TAPVC. The enlargement of left innominate vein-right superior vena cava draining to RA was seen in supracardiac TAPVC. Conclusion： A combination of suprasternal and subcostal multi-views in echocardiography can increase the diagnostic accuracy of TAPVC in pediatric patients.

关 键 词：超声心动描记术 肺静脉/畸形 房间隔缺损/超声检查 完全型肺静脉异位引流 诊断 

分 类 号：R725.4[医药卫生—儿科]