主动脉窦瘤的超声特点与漏诊分析  

Echocardiographic diagnosis of sinus of Valsalva aneurysm

作　　者：范瑞[1] 李杰[1] 李翠玲[1] 林红[1] 姚凤娟[1] FAN Rui;Li Jie;LI Cui-ling;LIN Hong;YAO Feng-juan(Department of Medical Ultrasonics//Institute of Diagnostic and Interventional Ultrasound,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院超声科//中山大学超声与介入诊断研究所,广州510080

出　　处：《中山大学学报（医学科学版）》2023年第1期169-174,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广州市科技计划项目(202201011468)。

摘　　要：【目的】总结主动脉窦瘤(SVA)的超声特点,分析漏诊原因,探讨SVA的超声诊断技巧,提高诊断率。【方法】回顾性分析2014年1月至2022年3月期间在中山大学附属第一医院行外科手术的52例SVA患者的超声心动图特征及手术资料,按改良Sakakibara分型分为5型。【结果】52例SVA患者中,男性32例,女性20例,年龄18~66(36.1±11.6)岁。其中44例窦瘤起自主动脉右冠窦,8例起自无冠窦,未见起自左冠窦的病例。Ⅰ型、Ⅱ型和Ⅲv型为膨入右心室的窦瘤共35例,32例(91.4%)合并室间隔缺损(VSD),Ⅲa型、Ⅳ型和Ⅴ型为膨入右心房或其他部位的窦瘤共17例,仅2例(17.6%)合并VSD。各型SVA均常合并主动脉瓣病变,因主动脉瓣病变情况较严重需要外科手术换瓣或成形者共27例(51.9%)。52例患者共有4例漏诊SVA,漏诊率为7.7%;8例漏诊VSD,漏诊率达23.5%,漏诊者多为I型SVA合并干下型VSD;各型SVA中均有合并感染性心内膜炎(IE)患者,共19例,其中有2例漏诊,漏诊率为10.5%。【结论】SVA声像图具有多样性和复杂性。膨入右心房的SVA较少合并VSD,而膨入右心室的SVA绝大多数合并VSD,但诊断具有挑战性,且SVA还易合并主动脉瓣病变和IE,进一步加大诊断难度。超声检查过程中必须提高警惕,灵活运用多个标准和非标准切面,减少漏诊,提高诊断率。【Objective】 To summarize the echocardiographic features of sinus of Valsalva aneurysm(SVA), analyze the causes of missed diagnosis, thus explore the diagnostic skills and improve the diagnostic accuracy for SVA.【Methods】 The echocardiographic features and clinical data of 52 SVA patients who underwent surgery in the First Affiliated Hospital of Sun Yat-sen University from January 2014 to March 2022 were retrospectively reviewed. The patients were divided into 5 types according to modified Sakakibara classification system.【Results】 There were 32 male and 20 female patients with their age of 18~66(36.1±11.6) years. Of the 52 aneurysms, 44 originated from the right coronary sinus(RCS), 8 from noncoronary sinus(NCS) and none from left coronary sinus(LCS). Among the 35 SVAs protruding into the right ventricle, including type I, type Ⅱ and type Ⅲv, 32(91.4%) were associated with ventricular septal defect(VSD). There were 2(17.6%) associated with VSD among the 17 SVAs protruding into the right atrium or other sites of the heart, including type Ⅲa, type Ⅳ and type Ⅴ. SVA was frequently associated with aortic valve disease, 27 cases(51.9%) of which needed surgical valve replacement or valvoplasty. SVA was missed in 4 patients and VSD in 8, with the misdiagnosis rates of 7.7% and 23.5%, respectively. The most commonly missed VSD diagnosis was subarterial VSD with type I SVA. Of the 19SVAs associated with infective endocarditis(IE), 2 were missed, with the misdiagnosis rate of 10.5%.【Conclusion】 The ultrasound images of SVA are diverse and complex. SVA protruding into the right atrium is rarely associated with VSD, while SVA protruding into the right ventricle is frequently associated with VSD. SVA is also prone to be associated with aortic valve disease and IE, which makes the diagnosis more challenging. Therefore, during ultrasound examination, we must vigilantly and flexibly make use of the multiple scan slices so as to decrease the rate of missed diagnosis and improve the diagnostic accuracy f

关 键 词：主动脉窦瘤 超声心动描记术 漏诊 

分 类 号：R540.45[医药卫生—心血管疾病]