小儿双主动脉弓的超声心动图诊断及漏诊分析  

Essentials in the diagnosis of double aortic arch by echocardiography

作　　者：谭玉玉 申俊君[2] 庞程程[2] 李江林[2] 蒋秋平 潘微[2] TAN Yu-yu;SHEN Jun-jun;PANG Cheng-cheng;LI Jiang-lin;JIANG Qiu-ping;PAN Wei(Department of NICU,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Department of Maternal-Fetal Cardiology,Guangdong Cardiovascular Institute,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510100,China)

机构地区：[1]广东省人民医院(广东省医学科学院)新生儿重症监护室,广州510080 [2]广东省心血管病研究所心脏母胎科广东省人民医院(广东省医学科学院),广州510080

出　　处：《岭南心血管病杂志》2020年第5期552-554,564,共4页South China Journal of Cardiovascular Diseases

基　　金：国家重点研发计划项目(项目编号:2018YFC1002602)。

摘　　要：目的评价彩色多普勒超声心动图对双主动脉弓的诊断价值,分析漏诊的原因。方法回顾性分析2013年1月至2019年9月广东省人民医院23例经外科手术证实为双主动脉弓患儿的超声心动图资料,以术中诊断为标准,与计算机断层扫描血管造影(computed tomography angiography,CTA)、心导管造影对比分析其声像图特点。结果13例为孤立性双主动脉弓,超声心动图诊断准确率为92.3%(12/13),漏诊率仅为7.7%(1/13)。合并心内畸形共10例,包括4例合并室间隔缺损,3例合并法洛四联症,1例合并完全性肺静脉异位引流,1例合并完全性大动脉转位、肺动脉瓣狭窄、室间隔缺损,1例合并部分型肺静脉异位引流、室间隔缺损。超声心动图诊断准确率为60%(6/10),漏诊率达40%(4/10)。其中22例患儿CTA明确诊断并评估气管情况,1例患儿行心导管检查确诊双主动脉弓。结论超声心动图对于诊断孤立性双主动脉弓灵敏性高,但对合并心内畸形特别是复杂心内畸形的双主动脉弓易漏诊。详细了解病史,与CTA共同评价大血管及气道情况,有助于提供完整的术前信息。Objectives To explore the value of echocardiography in the diagnosis of double aortic arch(DAA),and analyze the misdiagnostic cases to improve the correct rate of diagnosis.Methods The echocardiographic data of 23 patients with DAA confirmed by surgery were retrospectively analyzed from January 2013 to September 2019 in Guang⁃dong Provincial People's Hospital,and were compared with those of computed tomography angiography(CTA)and car⁃diac catheterization.Results The diagnostic accuracy of echocardiography was 92.3%(12/13),and the misdiagnostic rate was only 7.7%(1/13).There were 10 cases with cardiac malformation,including 4 cases with ventricular septal defect(VSD),3 cases with tetralogy of Fallot,1 case with total anomalous pulmonary venous connection,1 case with complete transposition of great arteries,pulmonary stenosis and VSD,1 case with partial anomalous pulmonary venous connection and VSD.The diagnostic accuracy of echocardiography was 60%(6/10),and the misdiagnostic rate was 40%(4/10).Among them,22 cases were diagnosed and evaluated by CTA,1 case was diagnosed by cardiac catheterization.Conclusions Echocardiography is highly sensitive to the diagnosis of isolated DAA,but it is easy to miss the diagnosis of complicated DAA.A detailed understanding of the history and evaluation of the large vessels and airway with CTA are helpful to provide complete preoperative information.

关 键 词：超声心动图 双主动脉弓 血管环 

分 类 号：R541.7[医药卫生—心血管疾病]