婴幼儿圆锥动脉干畸形型先天性心脏病合并冠状动脉异位起源的MSCT诊断  

MSCT diagnosis of conotruncal malformation with ectopic origin of coronary artery in infants and young children

作　　者：张秉权 刘永煕 邓宇[3] 曾庆思[3] ZHANG Bin-qian;LIU Yong-xi;DENG Yu(Department of Radiology,the People＇s Hospital of Baiyun District,,Guangzhou 510500,China)

机构地区：[1]广州白云区人民医院放射科,广州510500 [2]广东省妇幼保健院放射科 [3]广州医科大学附属第一医院放射科

出　　处：《放射学实践》2018年第6期622-626,共5页Radiologic Practice

摘　　要：目的:研究圆锥动脉干畸形型先天性心脏病合并冠状动脉异位起源的类型、发生率、构成比,探讨术前MSCT心脏成像诊断对术前计划制定的重要性。方法:回顾性分析276例经手术证实的圆锥动脉干畸形型先天性心脏病,所有患儿均在本院行MSCT心脏成像,并记录先天性心脏病类型、冠状动脉异位起源的类型及数量。对不同类型先天性心脏病的冠状动脉异位起源的发生率采用行×列Person卡方检验进行比较,对不同先天性心脏病的冠状动脉异位起源构成比采用Fisher确切概率法进行比较。与手术结果对照,探讨术前MSCT心脏成像诊断对术前计划制定的重要性。结果:圆锥动脉干畸形型先天性心脏病共276例,合并冠状动脉异位起源者47例,平均发病率为17%,其中肺动脉闭锁PA 11例,大动脉转位TGA 15例,法洛氏四联症TOF 4例,永存动脉干PTA 6例,右室双出口DORV 11例。在本组圆锥动脉干畸形型先天性心脏病伴发冠状动脉异位起源中,单冠状动脉SCA最多,占48.94%,其次为对侧冠状动脉或无冠窦起源OO,占29.79%,冠状动脉多发起源MO占14.89%,冠状动脉高位起源HO为4.26%,冠状动脉肺动脉起源PO最少,占2.13%。Fisher确切概率法比较,卡方值为15.452,P值为0.472,说明不同类型先天性心脏病的冠状动脉异位起源构成比差异无统计学意义,可以认为不同类型先天性心脏病的冠状动脉异位起源构成比不全相同,与圆锥动脉干畸形的严重程度相关。本研究冠状动脉异位起源发生率由高到低依次为PTA(35.3%)>TGA(27.3%)>DORV(25%)>PA(16.9%)>TOF(4.2%)。但是TGA的构成比高达32%。结论:不同类型圆锥动脉干畸形型先天性心脏病合并冠状动脉异位起源的发生率及构成比不同,与圆锥动脉干畸形的严重程度相关;我们应该更多地关注大动脉转位伴发冠状动脉异位起源的患儿。Objective：To study the type,incidence,and composition ratio of conotruncal malformation with ectopic origin of coronary artery in infants and young children,and to discuss the importance of preoperative cardiac imaging diagnosis with MSCT.Methods：A retrospective analysis of 276 cases of infants and young children with conotruncal malformation was performed.All patients underwent MSCT cardiac imaging in our hospital and recorded the type of congenital heart disease and the type and quantity of coronary ectopic origins.The incidence of coronary ectopic origin in different types of congenital heart disease was compared by the Pearson chi-square test.The ectopic origin of coronary arteries in different congenital heart diseases was compared by the Fisher exact test.Compared with the results of the surgery,To investigate the importance of preoperative MSCT cardiac imaging diagnosis in preoperative planning.Results：There were 276 cases of conotruncal malformation in infants and young children,and 47 cases were associated with coronary ectopic origin.The average incidence rate was 17%.There were 11 cases of pulmonary atresia（PA）,15 cases of transposition of the great arteries（TGA）,4 cases of tetralogy of Fallot 6 cases of persistent truncus arteriosus（PTA）and11 cases of double outlet right ventricle（DORV）.In this group of conotruncal malformations associated with different types of coronary ectopic origin,single-coronary（SCA）was the most common,accounting for 48.94%,followed by contralateral coronary or non-coronary sinus origin（OO）,accounting for 29.79%,coronary multi-origin（MO）in 14.89%,the high coronary origin（HO）was 4.26%,and the pulmonary artery origin of manary artery was the lowest,accounting for 2.13%.By the Fisher exact test,the chi-square value was 15.452,Pvalue was 0.472,indicating that the constitutional ratio among different type of conotruncal malformation with ectopic origin of coronary artery was not statistically significant,and it could be considered that different

关 键 词：动脉干 肺动脉 法乐四联症 右室双出口 动脉干 续存性 主动脉瓣狭窄 

分 类 号：R322.121[医药卫生—人体解剖和组织胚胎学] R542.52[医药卫生—基础医学]