经胸超声心动图诊断小儿左冠状动脉起源于肺动脉  

Transthoracic echocardiographic diagnosis of anomalous origin of left coronary artery from pulmonary artery in children

作　　者：王树水[1] 钱明阳[1] 李江林[1] 潘微[1] 徐衍梅[1] 李虹[1] 张智伟[1] 

机构地区：[1]广东省人民医院广东省医学科学院广东省心血管病研究所心儿科,广州510100

出　　处：《中华超声影像学杂志》2009年第8期665-668,共4页Chinese Journal of Ultrasonography

摘　　要：目的探讨小儿左冠状动脉起源于肺动脉（ALCAPA）的经胸超声心动图特点。方法对23例ALCAPA行超声心动图检查，14例行主动脉或右冠脉造影，21例进行外科手术治疗。结果超声检查9例左冠脉起源于肺动脉右后方，14例左冠脉起源于肺动脉左后方。22例患儿为左冠脉主干起源于肺动脉，1例为左冠脉旋支起源于肺动脉。全部病例均见右冠脉扩张、左室扩大及冠脉间侧支血流信号。23例分别经心脏CT、心导管检查及外科手术证实诊断。结论超声心动图能够明确诊断ALCAPA，但应注意与扩张型心肌病及心内膜弹力纤维增生症鉴别。部分小儿病例存在婴儿型与成人型的交叉重叠，难以截然分型。Objective To analyze transthoracic echocardiographic characteristics of anomalous origin of the left coronary artery from the pulmonary artery （ALCAPA） and to explore the diagnostic value of transthoracic echocardiography. Methods The transthoracic echocardiographic characteristics of twenty- three children hospitalized with ALCAPA from 1996 to 2008 were analyzed retrospectively. The origin sites, blood flow directions of coronary arteries, accompanied cardiovascular abnormalities and valvular regurgitations were investigated. Fourteen cases performed angiographies and 21 cases underwent cardiac surgery. Results Echocardiography showed abnormal vessel inserting into pulmonary artery, continuous shunt into pulmonary artery, left ventricle dilatation and intercoronary collateral signals in all cases. Echocardiography revealed the main left coronary artery originating from pulmonary artery in 22 cases and left circumflex coronary artery from pulmonary artery in one. The diagnosis of ALCAPA was confirmed by angiocardiography or intraoperative findings in 22 patients and confirmed by cardiac spiral CT in one case. Conclusions Echoeardiography can reveal the left coronary artery originating from pulmonary artery,but it is still important to differentiate this abnormality from cardiomyopathy and endocardial fibroelastosis. Some pediatric patients have overlapped characteristics of both infant and adult type.

关 键 词：超声心动描记术 冠状血管畸形 

分 类 号：R686[医药卫生—骨科学]