彩色多普勒超声心动图在法洛三联症介入治疗中的价值  

Value of color Doppler echocardiography on the interventional treatment of trilogy of Fallot

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

机构地区：[1]沈阳军区总医院先心病内科,沈阳市110840 [2]辽宁省人民医院超声科

出　　处：《临床超声医学杂志》2012年第12期812-815,共4页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨彩色多普勒超声心动图(CDE)在法洛三联症(TOF)介入治疗中的价值。方法选取31例经CDE筛选的31例TOF患者进行介入治疗,通过CDE术中监测及术后1、3、6个月跟踪随访,判断介入治疗的疗效。结果根据CDE图像特征表现对28例做出准确诊断,诊断符合率90.3%,漏诊3例,其中2例被误诊为继发孔房间隔缺损(ASD),1例被误诊为室间隔完整的肺动脉闭锁。二维超声心动图测量ASD直径5～28mm,平均(17.3±10.2)mm,与介入治疗术中测量ASD直径7～30mm,(18.4±11.1)mm]比较,差异无统计学意义;连续多普勒估测跨肺动脉瓣压力阶差36～154mm Hg(1mm Hg=0.133kPa),平均(92±54)mm Hg,与心导管测量跨肺动脉瓣压力阶差[30～140mm Hg,平均(85±48)mm Hg]比较,差异无统计学意义;介入治疗后连续多普勒估测跨肺动脉瓣压力阶差下降至16～30mm Hg,平均(23±6)mm Hg。31例入选患者经实施介入治疗后均获得成功。介入治疗后1、3、6个月随访,无过房间隔分流束血流信号。结论 CDE在TOF介入治疗术前筛选适应证,判断ASD大小、位置、残余边缘和肺动脉瓣狭窄程度,术中监测和术后随访判断疗效,判定封堵器位置是否正常、有无过房间隔残余分流束血流信号及估测跨肺动脉瓣压力阶差下降程度中具有重要价值。Objective To explore the value of color Doppler echocardiography（CDE） on the interventional treatment of the trilogy of Fallot （TOF）. Methods Thirty-one cases of TOF patients were referred to interventional treatment according to CDE, monitored by CDE during the treatment, and were followed up for 1 month, 3 months and 6 months. The effect of the treatment was also evaluated by CDE. Results Twenty-eight patients were diagnosed correctly based on CDE characteristics. The diagnostic coincidence rate was 90.3%. Two cases were misdiagnosed as secondum atrial septum defect （ASD）, 1 case was misdiagnosed as pulmonary atresia with intact ventricular septum. The diameter of ASD was 5-28 mm[ （17.3±10.2） mm] measured by 2DE, while it was 7-30 mm[ （ 18.4±11.1 ） mm] by surgical measurement, but which were not statistically different. Transpulmonary valve pressure gradient estimating by CW was 36-154 mm Hg [ （92±54） mm Hg ], while it was 30~ 140 mm Hg [ （ 85 ±48 ） mm Hg ] by cardiac catheterization, but which were not statistically different. After the treatment, the pressure decreased to 16-30 mm Hg [ （23±6） mm Hg ]. Thirty-one patients were successfully performed interventional treatment. During follow up of 1 month, 3 months and 6 months,no residual shunt through ASD were detected. Conclusion CDE was valuable to the interventional treatment of TOF. It is very important from diagnosis of TOF, screening indications for interventional treatment, assessing the size, position, the margin of ASD, the severity of pulmonary, monitoring during intervention, to the following up after the treatment as the position of the Amplaza, any residual shunt across ASD and the decreasing degree of transpulmonary valve pressure gradient.

关 键 词：超声心动描记术 心脏缺损 先天性 法洛三联症 介入治疗 

分 类 号：R541[医药卫生—心血管疾病] R540.45[医药卫生—内科学]