全腔静脉-肺动脉连接术后紫绀原因的超声心动图诊断  

Diagnosis of cyanosis after total cavopulmonary connection by echocardiography

作　　者：李慧 齐红霞 海兴瑞 闫军 逄坤静 王剑鹏 LI Hui;QI Hong-xia;HAI Xing-rui;YAN Jun;PANG Kun-jing;WANG Jian-peng(Beijing Fuwai Hospital,Chinese Academy of Medical Science,Beijing 100037,China)

机构地区：[1]中国医学科学院阜外医院,北京100037

出　　处：《中国临床医学影像杂志》2020年第10期727-729,共3页Journal of China Clinic Medical Imaging

摘　　要：目的:探讨超声心动图在全腔静脉-肺动脉连接术(Total cavopulmonary connection,TCPC)后紫绀原因诊断中的应用。方法:回顾分析180例TCPC术后患者临床资料,并对25例术后出现紫绀患者的超声心动图结果进行分析。结果:10例围术期出现严重低氧血症,超声检查示膈肌麻痹、胸腔积液、肺不张,治疗后随访紫绀好转;5例超声检查示外管道开窗过大;4例遗漏单支肝静脉直接回流入心房;1例外管道内血栓形成并狭窄,术中结扎的导引静脉开放,形成下腔静脉-肝静脉-门静脉-导引静脉-共同肺静脉干-心房逆流;5例常规超声检查无明显异常,声学造影示肺动静脉瘘。结论:超声心动图显示TCPC术后患者心内结构及血流动力学变化,在术后紫绀原因诊断中发挥关键作用。Objective:To explore the value of the echocardiography in the diagnosis of patients with cyanosis after total cavopulmonary connection(TCPC).Methods:Clinical data of 180 patients after TCPC were retrospectively reviewed,and echocardiographic results of 25 patients with postoperative cyanosis were analyzed.Results:In 10 cases,severe hypoxemia occurred during perioperative period.Echocardiographic examination showed diaphragmatic paralysis,pleural effusion and atelectasis.In 5 cases,examination showed that the extracardiac conduits had too large window,while 4 cases missed a seperate hepatic vein and returned directly to the atrium.One case had thrombosis of extracardiac conduit and stenosis,and ligated guidance vein opened,resulting in the formation of inferior vena cava-hepatic vein-portal vein-guidance vein-common pulmonary vein trunk and atrial reflux.There were no obvious abnormalities in the routine echocardiography of 4 cases,and the pulmonary arteriovenous fistula was revealed by contrast echocardiography.Conclusion:Echocardiography showed changes in cardiac structure and hemodynamics after TCPC,which played a key role in the postoperative diagnosis of cyanosis.

关 键 词：心脏病 发绀 超声心动描记术 多普勒 彩色 

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