主动脉窦瘤膨入左心室的超声心动图特征  

Echocardiographic features of sinus of Valsalva aneurysm extending into left ventricle

作　　者：张文竞[1] 杨亚利[1] 谢明星[1] 王新房[1] 吕清[1] 贺林[1] 王静[1] 李玲[1] 张静[1] 王艺[1] 刘金凤[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院超声影像科,武汉430022

出　　处：《中华心血管病杂志》2016年第6期513-517,共5页Chinese Journal of Cardiology

摘　　要：目的探讨主动脉窦瘤膨人左心室的超声心动图特征。方法回顾性分析1995年7月至2015年9月在华中科技大学同济医学院附属协和医院行外科手术的5例主动脉窦瘤膨入左心室患者的超声心动图特征，并对超声心动图诊断与外科手术结果进行比较。其中，主动脉窦瘤膨入左心室采用常规和实时三维超声心动图联合诊断4例，采用常规超声心动图诊断1例。结果与外科手术结果比较，超声心动图除漏诊1例毗邻主动脉瓣发育不良外，准确诊断主动脉窦瘤起源、膨入部位、是否破裂、主动脉窦瘤并发症和合并的心血管畸形。主动脉窦瘤膨入左心室具有窦瘤的共性特征，超声心动图表现为起自主动脉根部的薄壁囊袋结构、与瓣环纤维延续、瘤体有明显形变和摆动。同时还有以下特殊超声心动图表现：窦瘤均低位起源，开口于主动脉瓣环与窦壁基底之间；4例室间隔完整患者的瘤体摆动于左心室流出道与主动脉根部之间，1例合并大室间隔缺损患者的瘤体经缺损摆动于左心室与右心室之间；窦瘤破裂时表现为舒张期分流；均见窦瘤内口推移毗邻主动脉瓣环致瓣环移位，主动脉瓣环和瓣叶脱垂，并引起严重关闭不全；2例患者因窦瘤占位效应导致左心室流出道梗阻。结论主动脉窦瘤膨人左心室有特殊的超声心动图表现，常规和实时三维超声心动图能较准确地诊断本病。Objective To observe image features of sinus of Valsalva aneurysm （SVA） extending into left ventricle by echocardiography. Methods Echocardiographic features of 5 cases of SVA extending into left ventricle and underwent surgery at Union Hospital from July 1995 to September 2015 were reviewed retrospectively and image and surgical findings were compared. A total of 4 patients were diagnosed by conventional and 3D echocardiography before surgery, and 1 patient was diagnosed by conventional echocardiography. Results The origin, extending position, rupture status, complications of the SVA and associated cardiovascular lesions determined by echocardiography were entirely consistent with surgical findings in all cases, with the exception of one failed diagnosis of hypoplasty of an adjacent aortic cusp. Besides the common features of SVA, echocardiographic features of SVA extending into left ventricle included a thin-walled saccular lesion arising from the aortic root in continuation with the aortic annulus, with significant morphological changes and movement. Moreover, following features were observed ： very low origin of the saccular lesion arising between the sinus base and the aortic annulus ; the aneurysm going back and forth between the aortic root and the left ventricular outflow tract in 4 cases with an intact interventricular septum, and between the left ventricle and the right ventricle through the septal defect in another case complicated by a huge ventricular septal defect; diastolic shunt into the left ventricle when ruptured; displacement of the adjacent aortic annulus due to compression of aneurismal origin and prolapse of both aortic valve and annulus observed in all cases, resulting in a severe aortic regurgitation; obstructions of the left ventricular outflow tract due to the space-occupying effect were also found in 2 cases. Conclusion The SVA extending into left ventricle has distinguished echocardiographic characteristics, which could be accurately diagnosed either by conventional or real-time

关 键 词：VALSALVA窦 心室 超声心动描记术 

分 类 号：R540.45[医药卫生—心血管疾病] R654.2[医药卫生—内科学]