成人心室双入口彩色多普勒超声心动图特征研究  

Image characteristics of color Doppler echocardiography in adults with double-inlet ventricle

作　　者：侯传举[1] 邹苏娅[2] 邓东安[1] 朱鲜阳[1] 韩秀敏[1] 刘剑立[1] 胡斌[3] 王巧玲[1] 

机构地区：[1]沈阳军区总医院,沈阳110840 [2]解放军第208医院,长春160063 [3]武警辽宁省总队医院,沈阳110034

出　　处：《岭南心血管病杂志》2011年第6期482-485,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的探寻成人心室双入口(double-inlet ventricle,DIV)彩色多普勒超声心动图(color Dopplerechocardiography,CDE)特征。方法应用CDE检查32例成人DIV患者,寻找其CDE特征,所有患者均有心血管造影对照,25例经手术证实。结果根据CDE特征表现对30例做出正确诊断,诊断准确率93.8%,2例误诊右心室双出口。成人DIV的CDE特征明显:(1)在二维超声心动图(two-dimensional echocardiography,2DE)心尖四腔心切面显示房间隔回声完整,室间隔回声全部失落,收缩期显示两组房室瓣关闭,心内十字交叉消失,呈"T字形"改变,称2DE"T字征";舒张期显示两组房室瓣开向一个共同心室腔。彩色多普勒血流显像于舒张期显示两个心房内血流信号通过两组房室瓣进入一个共同心室腔。(2)根据2DE心尖四腔心切面共同心室腔表现确定DIV心室的类型,其中A型共同心室心内膜和肌小梁回声细腻(65.6%,21/32),B型共同心室心内膜和肌小梁回声粗糙(6.3%,2/32),C型共同心室心尖部显示球室嵴回声(28.1%,9/32)。(3)在2DE胸骨旁大动脉短轴切面判断大动脉的类型,其中Ⅰ型大动脉位置关系正常(15.6%,5/32),Ⅱ型和Ⅲ型显示两条大动脉呈两个环状回声,通过两个环状回声相互位置关系判定转位的类型,其中Ⅱ型两个环状回声呈右前左后排列(21.9%,7/32);Ⅲ型两个环状回声呈左前右后排列(62.5%,20/32)。通过两环内径比较判定是肺动脉狭窄还是肺动脉高压,其中肺动脉狭窄时肺动脉内径明显小于主动脉内径(96.9%,31/32);肺动脉高压时肺动脉内径明显大于主动脉内径(3.1%,1/32)。(4)合并肺动脉狭窄患者彩色多普勒血流显像于收缩期显示过肺动脉五彩镶嵌射流束血流信号。(5)成人DIV患者男性明显多于女性[65.6%(21/32)vs.34.4%(11/32)]。结论成人DIV的CDE特征明显,CDE对成人DIV有特异性诊断价值。Objectives To explore the image characteristics of color Doppler echocardiography （CDE） in adults with double-inlet ventricle （DIV）. Methods Thirty-two adult patients with DIV were examined by CDE,and angiocardiography results were taken for contrast. Among them, 25 cases were confirmed by operation. Results Thirty adult cases were accurately diagnosed as DIV by CDE, and the accuracy rate reached 93.8% （30/32）. Two cases were misdiagnosed as double-outlet right ventricle. The CDE characteristics in adults with DIV were as below ： （ 1 ） Apical four- chamber views of two-dimensional echocardiography （2DE） showed intact atrial septum and total echo loss of ventricular septum. During systole, two atrioventricular valves closed, the＂＋＂sign was replaced by＂T＂ sign of 2DE; and during diastole, two atrioventricular valves opened to the one common ventricle. Color Doppler flow imaging （CDFI） showed that flow signals from the two atrium entered one common ventricle through two atrioventricular valves. （2）According to the features of the common ventricle on apical four-chamber view of 2DE, the ventricle of DIV could be derided into 3 types, as type A （65.6%, 21/32） with delicate echo in endocardium and trabecular muscles, type B （6.3%, 2/32） with coarse echo, and type C （28.1%, 9/32）, bulboventricular ridge could be seen in the apex of the common ventricle. （3）Type of the great arteries could be judged by view of parastemal short axis. Type I showed normal relationship of the two great arteries （ 15.6%, 5/32）. Type Ⅱ and Ⅲ showed the same two circular echo signals of the two great arteries, but with different spatial relationships of the two circles, type Ⅱ （21.9% ,7/32） showed the two circles located in anterior right-posterior left direction and type Ⅲ 〈 62.5%, 20/32） showed the two circles in anterior left-posterior right direction. The size of the two circles could be used to distinguish between pulmonary stenosis and pulmonary hypertension. Pul

关 键 词：心脏缺损 先天性 心室双入口 超声心动描记术 彩色 多普勒 

分 类 号：R541.1[医药卫生—心血管疾病]