小儿左冠状动脉起源于肺动脉所致心脏扩大22例误诊分析  

Analysis of misdiagnosis of anomalous origin of left coronary artery from pulmonary artery with cardiomegaly in infants and children

作　　者：王树水[1] 李渝芬[1] 钱明阳[1] 潘微[1] 黄美萍[2] 李虹[1] 徐衍梅[1] 李江林[1] 张智伟[1] 陈欣欣[3] 庄建[3] 

机构地区：[1]广东省心血管病研究所广东省人民医院广东省医学科学院心儿科,广州510080 [2]广东省心血管病研究所广东省人民医院广东省医学科学院放射科,广州510080 [3]广东省心血管病研究所广东省人民医院广东省医学科学院心外科,广州510080

出　　处：《中国实用儿科杂志》2009年第6期450-454,共5页Chinese Journal of Practical Pediatrics

摘　　要：目的探讨小儿左冠状动脉起源于肺动脉(ALCAPA)所致心脏扩大病例的误诊原因,总结诊断经验。方法回顾性分析1996年7月至2009年1月广东省心血管病研究所22例小儿ALCAPA所致心脏扩大的误诊病例。均行心电图、X线胸片、超声心动图检查,8例行心脏CT检查,14例行心导管检查及造影,21例进行了外科手术治疗。结果≤1岁患儿10例中,6例误诊为心内膜弹力纤维增生症,3例误诊为扩张型心肌病,1例误诊为先天性二尖瓣脱垂并关闭不全。>1岁患儿12例中,4例误诊为扩张型心肌病,3例误诊为心内膜弹力纤维增生症,2例误诊为先天性二尖瓣脱垂并关闭不全,1例误诊为右冠状动脉右心室瘘,1例误诊为川崎病,1例误诊为动脉导管未闭。结论小儿ALCAPA所致心脏增大病例容易误诊为心内膜弹力纤维增生症、扩张型心肌病、先天性二尖瓣脱垂等疾病,左冠状动脉起源于肺动脉后方偏右的病例更易误诊。提高对ALCAPA的认识、超声或CT检查中仔细探查冠状动脉及其起源对避免误诊至关重要。Objective To analyze the experience of misdiagnosis of anomalous origin of left coronary artery from pulmonary artery （ALCAPA） with cardiomegaly in infants and children. Methods A total of twenty-two infants and children with ALCAPA and secondum cardiomegaly who had once been misdiagnosed from 1996 to 2009 were analyzed retrospectively. The examination included electrocardiography, chest X-ray, echocardiography, computed tomography and angiographies.Totally 21 patients underwent cardiac operation. Results In cases of infants, 6 were misdiagnosed with endocardial fibroelastosis, 3 with dilated cardiomyopathy, and one with congenital mitral valve prolapse. In cases of children, 4 were misdiagnosed with dilated cardiomyopathy, 3 with endocardial fibroelastosis, 2 with congenital mitral valve prolapse, 1 with right coronary artery fistula, 1 with Kawasaki disease and 1 with patent ductus arteriosus. The diagnoses of ALCAPA were confirmed by cardiac surgery in 21 cases. Conclusion The cases with ALCAPA and secondum cardiomegaly are easily misdiagnosed with endocardial fibroelastosis, dilated cardiomyopathy, congenital mitral valve prolapse and coronary artery fistula. It is important to carefully identify the origin of left coronary in echocardiography and computed tomography, and this can differentiate ALCAPA from other diseases.

关 键 词：冠状血管畸形 心脏增大 超声心动图描记术 计算机体层摄影术 心肌病 

分 类 号：R72[医药卫生—儿科]