法洛三联症彩色多普勒超声心动图特征和规律性研究  

Characteristics and Regularity of Trilogy of Fallot in Color Doppler Echocardiography

作　　者：侯传举[1] 朱芳[2] 邓东安[1] 朱鲜阳[1] 韩秀敏[1] 张端珍[1] 王琦光[1] 

机构地区：[1]沈阳军区总医院,沈阳市110840 [2]辽宁省人民医院

出　　处：《中国超声医学杂志》2012年第6期525-528,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨法洛三联症(TOF)彩色多普勒超声心动图(CDE)特征,分析房间隔缺损(ASD)血流动力学与肺动脉瓣狭窄(PS)程度的关系,提高诊断准确率。方法应用CDE检查122例TOF,二维超声心动图(2DE)测量ASD大小,连续波多普勒(CW)估测跨肺动脉瓣压力阶差,与心导管和手术对照。其中82例行心导管检查,3l例行介入治疗,91例外科手术治疗。结果根据CDE特征表现对112例做出正确诊断,诊断准确率91.8%,误诊继发孔ASD5例、PS 4例、室间隔完整的肺动脉闭锁1例。2DE测量ASD直径5～33 mm,平均(18±12)mm与手术测量ASD)直径7～35 mm,平均(20±12)mn。呈正相关(r=0.52.P<0.001);CW估测跨肺动脉瓣压力阶差36～154 trim Hg.平均(78±40)mm Hg与心导管测量跨肺动脉瓣压力阶差30～140 mm Hg,平均(75±45)mm Hg。呈正相关(r=0.61,P<0.001)。彩色多普勒血流显像(CDFI)显示过房间隔分流束血流信号,其中左向右(60.6%)、双向(23.0%)、右向左(11.5%)和无分流(4.9%)。根据CDE筛选31例适应证实施介入治疗全部获得成功。结论 TOF的CDE特征明显,CDFI显示过ASD分流呈多样化,与PS程度密切相关,CDE对TOF有特异性诊断价值,介入治疗前应用CDE判断ASD大小、位置和PS程度非常重要。Objective To explore color Doppler echocardiography（CDE） features of the trilogy of Fallot （TOF）, and analysis the relationship between the hemodynamic atrial septal defect（ASD） and the degree of pulmonary stenosis （PS） to improve the diagnostic accuracy. Methods One hundred and twenty-two trilogy of Fallot patients were exam- ined by CDE, ASD size was measured by two-dimensional echocardiography, and transpulmonary valve pressure gradi- ent was estimated by continuous wave Doppler（CW）. 82 cases were compared with angiocardiography, 31 cases un derwent interventional therapy, and 91 cases were verified by operation. Results One hundred and twelve patients were correctly diagnosed based on CDE characteristics with diagnosis accuracy 91.8%. 5 case was misdiagnosed as secondum ASD, 4 case was misdiagnosed as PS and 1 case was misdiagnosed as pulmonary atresia with intact ventricu- lar septum. The diameter of ASD was 5 mm to 33 mm（18±12 mm） by 2DE, while the diameter was 7 mm to 35 ram （20±12 mm） by surgical measurement, they were positively correlated （r=0.52,P〈0. 001）. Transpulmonary valve pressure gradient estimated by CW was 36 mm Hg to 154 mm Hg （78±40 mm Hg）, while the pressure gradient was 30 mm Hg to 140 mm Hg by cardiac catheterization （75±45 mm Hg）, they were positively correlated （r=0.61,P〈0. 001）. The shunt throuh interatrial septum was shown by color Doppler flow imaging（CDFI）. 4 kinds of directions through ASD includes left to right（60.6%）, two-way（23.0%）, right to left（ll. 5%） and no shunt（4.9%）. 31 cases indicated for interventional treatment by CDE screening were all succeeded in interventional treatment. Conclusions The characteristics of TOF by CDE were obvious, CDFI showed that the shunt was diversificated, and closely correla- ted with PS degree. CDE had characteristic diagnostic value. It was very important for judging the size, location of ASD and PS degree by CDE before interventional treatment.

关 键 词：先天性心脏病 法洛三联症 彩色多普勒超声心动图 

分 类 号：R725.4[医药卫生—儿科] R540.45[医药卫生—临床医学]