永存第五对主动脉弓的影像诊断  

Anatomical Features of Persistent Fifth Aortic Arch Evaluated by Various Imaging Modalities

作　　者：禹纪红[1] 支爱华[1] 李楠[1] 王恩宁[1] 祁晓鸥[1] 蒋世良[1] 戴汝平[1] 吕滨[1] YU Jihong;ZHI Aihua;LI Nan;WANG Enning;QI Xiaoou;JIANG Shiliang;DAI Ruping;LYU Bin(Department of Radiology,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院放射科,北京市100037

出　　处：《中国循环杂志》2021年第10期1020-1026,共7页Chinese Circulation Journal

摘　　要：目的:探讨永存第五对主动脉弓(PFAA)的解剖学特征,评价几种常用影像学方法的诊断价值。方法:回顾分析2010年10月至2019年9月中国医学科学院阜外医院诊断的8例PFAA患者,收集其临床、影像及手术资料,总结其解剖及影像学特征、类型和伴发畸形情况,对比X线胸片、超声心动图、CT血管造影(CTA)检查结果。结果:本组8例患者中,7例的PFAA与主动脉弓位于同侧、不形成血管环结构,4例的PFAA伴发狭窄及闭锁,8例PFAA均起自升主动脉远端无名动脉开口旁或对侧,6例止于降主动脉近端,2例止于一侧肺动脉干;8例患者均合并心血管畸形,包括室间隔缺损、主动脉弓离断、法乐四联症、动脉导管未闭、共同动脉干、右心室双出口、肺动脉闭锁,以室间隔缺损和主动脉弓离断最常见;CTA对8例PFAA及伴发的其他心血管畸形患者均做出准确诊断,其准确度优于超声心动图及造影结果。结论:PFAA的解剖特征为:起自升主动脉远端无名动脉开口旁或对侧、止于降主动脉近端或一侧肺动脉干,呈弓状血管结构,部分伴发狭窄及闭锁,常合并其他心血管畸形。CTA为PFAA首选的无创检查方法,可部分替代或补充血管造影结果。Objectives:To investigate the anatomical features of patients with persistent fifth aortic arch(PFAA)and evaluate the role of CT and other commonly used imaging modalities in the diagnosis of PFAA.Methods:Present study included 8 patients diagnosed as PFAA in our hospital from October 2010 to October 2019.The clinical data and surgical outcomes were collected,the imaging findings including plane chest film,ultrasound,CT,and angiography were analyzed,and the anatomical features,types and associated malformations of PFAA were summarized.Results:In this group,87.5%(7/8)PFAA was on the same side of the aortic arch,without vascular ring structure.50.0%(4/8)PFAA was associated with stenosis and atresia.In the 8 cases,all the PFAA originated from the distal ascending aorta opposite or proximal to the ostium brachiocephalic artery.75.0%(6/8)PFAA ended at the proximal end of the descending aorta,and 25.0%(2/8)PFAA ended at the pulmonary trunk.All 8 PFAA cases were complicated with other cardiovascular malformations,including Tetralogy of Fallot(TOF),interrupted aortic arch(IAA),ventricular septal defect(VSD),patent ductus arteriosus(PDA),double outlet of right ventricle(DORV),pulmonary atresia(PA).The most common malformations were VSD and IAA.Accurate diagnosis of PFAA and associated cardiovascular malformations was achieved by CTA in all 8 cases,CTA was superior to echocardiography and digital subtraction angiography(DSA)on the diagnosis of PFAA and associated cardiovascular malformations.Conclusions:Our results show that the anatomical features of the PFAA are as follows:arising from the ascending aorta opposite or proximal to the brachiocephalic artery,and terminating in the proximal end of the descending aorta or pulmonary trunk,with an arched vascular structure.PFAA is prone to stenosis and atresia,and often associated with other cardiovascular malformations.CTA serves as the first choice of the non-invasive diagnosis of PFAA and could be used as a promising alternative to DSA for evaluating PFAA.

关 键 词：主动脉 畸形 第五弓 先天性心脏病 计算机断层摄影术 

分 类 号：R541.4[医药卫生—心血管疾病]