超声心动图对儿童先天性冠状动脉起源异常的应用价值  

The application value of echocardiography in children with abnormal origin of congenital coronary artery

作　　者：许昌庆 沈琪 吴梦琦 肖昕 夏晓伟 XU Chang-qing;SHEN Qi;WU Meng-qi;XIAO Xin;XIA Xiao-wei(Department of Ultrasound,Anhui Children′s Hospital,Affiliated Pediatric Hospital of Fudan University,Hefei 230041,Anhui,China)

机构地区：[1]复旦大学附属儿科医院、安徽省儿童医院超声科,安徽合肥230041

出　　处：《广东医学》2023年第7期901-905,共5页Guangdong Medical Journal

摘　　要：目的探讨超声心动图对儿童先天性冠状动脉起源异常的诊断及应用价值。方法回顾性分析经超声心动图(ultrasound cardiography,UCG)、CT血管成像(computed tomography angiography,CTA)或手术证实的冠状动脉起源异常患儿的超声影像学表现及误诊情况。结果16例冠状动脉起源异常(CAOA)患儿中,左冠状动脉异常起源于右冠状动脉窦(AAORCA)3例;右冠状动脉异常起源于左冠状动脉窦(AAOLCA)5例;左冠状动脉异常起源于肺动脉(ALCAPA)8例。超声影像学表现为左、右冠状动脉开口于对侧冠状动脉窦或肺动脉,室间隔心肌内血流丰富,心肌缺血严重时表现为二尖瓣乳头肌及腱索回声增强、瓣叶活动僵硬、心内膜回声增强,心脏扩大、心功能减低等。移植术后患儿左室大小较术前缩小,心功能指标较术前明显好转。结论超声心动图由于无创、安全、可重复性好、准确率高已经成为冠状动脉起源异常诊断及术后评估最首要的检查。对不明原因晕厥、胸痛以及劳累患儿应警惕冠状动脉起源异常的可能,仔细观察冠状动脉,减少漏诊误诊,对于患儿早诊断、早治疗及改善预后具有重要价值。Objective To investigate the diagnostic value and application of echocardiography in children with congenital anomalous coronary artery origin.Methods A retrospective analysis was conducted on the echocardiographic findings and misdiagnoses of children with confirmed anomalous coronary artery origin using echocardiography(ultrasound cardiography,UCG),CT angiography(computed tomography angiography,CTA),or surgical confirmation.Results Among 16 children with anomalous coronary artery origin(CAOA),3 cases had left coronary artery originating from the right coronary sinus(AAORCA),5 cases had right coronary artery originating from the left coronary sinus(AAOLCA),and 8 cases had left coronary artery originating from the pulmonary artery(ALCAPA).Echocardiographic findings showed that the left or right coronary artery opened into the opposite coronary sinus or pulmonary artery,with rich blood flow in the interventricular septum.Severe myocardial ischemia was characterized by enhanced echogenicity of papillary muscles and chordae tendineae,stiffened valve leaflet movement,enhanced endocardial echoes,enlarged heart,and reduced cardiac function.After transplantation,the left ventricle size in postoperative children decreased compared to pre-operation,and cardiac function significantly improved.Conclusion Echocardiography is a non-invasive,safe,and highly accurate imaging modality with good repeatability,and it has become the primary examination for diagnosing anomalous coronary artery origin and postoperative assessment.Clinicians should be vigilant about the possibility of anomalous coronary artery origin in children with unexplained syncope,chest pain,or exertion.Thoroughly observing the coronary artery can help reduce misdiagnoses and provide early diagnosis,treatment,and improved prognosis for affected children.

关 键 词：超声心动图 冠状动脉起源异常 诊断 

分 类 号：R540.45[医药卫生—心血管疾病] R725.4[医药卫生—内科学]