超声心动图诊断心内畸形矫治术后左心室-右心房通道形成的价值  

Echocardiography in diagnosis of left ventricular-right atrial communication after surgical correction of intracardiac anormalies

作　　者：李文秀[1] 耿斌[1] 吴江[1] 杨爽[1] 苏俊武[1] LI Wenxiu;GENG Bin;WU Jiang;YANG Shuang;SU Junwu(Pediatric Cardiovascular Center,Beijing Anzhen Hospital Affiliated to Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院小儿心脏中心,北京100029

出　　处：《中华实用诊断与治疗杂志》2020年第11期1145-1147,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：北京市自然科学基金(7202040)。

摘　　要：目的探讨心内畸形矫治术后获得性左心室-右心房通道(left ventricular-right atrium communication,LVRAC)诊断及随访中应用超声心动图的价值。方法回顾性分析25例心内畸形矫治术(24例行膜周部室间隔缺损修补术、1例行右心室双出口根治术)后发生LVRAC患者的超声心动图声像资料。结果25例超声心动图均明确诊断为LVRAC,其中1例行右心室双出口根治术者术后中度肺动脉高压并三尖瓣反流,术后2年肺动脉高压降至轻度时确诊LVRAC。LVRAC超声心动图声像在心尖四腔及剑下四腔心切面显示三尖瓣隔瓣与二尖瓣前瓣之间可见回声中断区,其缺损位于三尖瓣环上方;彩色多普勒血流显像示收缩期左心室与右心房之间的异常高速射流分流信号。25例中2例行LVRAC矫治术,术后随访4~36个月,复查超声心动图示通道消失;23例未予特殊治疗者6~60个月复查超声心动图示通道大小及分流速度无明显变化,无明显临床症状。结论超声心动图在先天性心脏病术后获得性LVRAC诊断及随访中有重要价值,但存在肺动脉高压并三尖瓣反流时易漏诊。Objective To explore the value of echocardiography to the diagnosis and follow-up of acquired left ventricular-right atrial communication(LVRAC)after surgical correction of intracardiac anormalies.Methods The ultrasonographic data of 25patients with LVRAC after surgical correction of intracardiac anormalies were retrospectively analyzed,including repair of perimembranous ventricular septal defect in 24patients,and double-outlet radical resection of right ventricle in 1patient.Results In 25patients with definite diagnosis of LVRAC by echocardiography,one patient had moderate pulmonary hypertension and tricuspid valve regurgitation after double-outlet radical resection of right ventricle,and was not diagnosed until the pulmonary hypertension turned from moderate to mild two years after operation.The echocardiography showed a small defect between tricuspid septal leaflet and mitral anterior leaflet in para four-chamber view of apex and subxiphorid,and the defect was located above tricuspid annulus.Color Doppler flow imaging showed abnormal high-velocity jet blood flow signal between left ventricle and right atrium during systole.Two of these 25patients underwent LVRAC correction,and LVRAC disappeared on echocardiogram during 4-to 36-month follow-up.The other 23patients receiving no special treatment were found neither obvious changes of size and shunt velocity of LVRAC on echocardiogram nor clinical symptoms during 6-to 60-month follow-up.Conclusion Echocardiography is of great value to the diagnosis of aquired LVRAC after congenital heart disease surgery,but it is easy to miss the diagnosis when the patients are complicated with pulmonary hypertension and tricuspid regurgitation.

关 键 词：先天性心脏病 左心室-右心房通道 超声心动图 室间隔缺损 

分 类 号：R654.2[医药卫生—外科学]