儿童冠状动脉异常主动脉起源伴大动脉间走行的临床特点和超声漏误诊分析  

Clinical Characteristics and Misdiagnosis or Missed Diagnosis Analysis of Echocardiography for Anomalous Aortic Origin of a Coronary Artery with Inter-Artery Course in Children

作　　者：薛丽 杨娇 孙妍[1] 李静雅[1] 刘国文 徐丽媛 马宁[1] Xue Li;Yang Jiao;Sun Yan;Li Jingya;Liu Guowen;Xu Liyuan;Ma Ning(Department of Echocardiography,Cardiac Center,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院心脏超声科,北京市100045

出　　处：《中国超声医学杂志》2024年第3期283-287,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的 总结分析冠状动脉异常主动脉起源(AAOCA)伴大动脉间走行患儿的临床特点并探讨超声心动图对该病的诊断价值,分析可能漏诊、误诊原因。方法 回顾性分析37例AAOCA患儿的临床资料,汇总临床症状、心肌酶、心电图等结果,对比经胸超声心动图与冠脉CT血管造影(CTA)检查结果,观察超声心动图图像特点,分析可能漏诊、误诊原因。结果 本组患儿共包含左冠状动脉异常起源(ALCA)5例、右冠状动脉异常起源(ARCA)32例,中位年龄7岁。4例(80%)ALCA患儿主诉运动中晕厥或抽搐,伴心电图ST段压低、心肌酶明显增高;10例(31%)ARCA患儿主诉胸痛、胸闷,余因其他原因就诊时偶然发现。21例(66%)ARCA患儿伴心律失常。超声漏诊ALCA患儿2例(40%)、ARCA患儿11例(34%)。超声漏诊、误诊率较高,分析原因可能与超声伪像、超声立体分辨力低及医师对该病认识不足等相关。结论 通过结合患儿临床表现、联合彩色及二维超声、加强冠脉开口的探查、加强超声开口伪像的鉴别有助于减少超声对该病的漏误诊。Objective To analyze and summarize the clinical characteristics of children with anomalous aortic origin of a coronary artery(AAOCA) with inter arterial course,to explore the diagnostic value of echocardiography for this disease,and to analyze the possible reasons for missed diagnosis and misdiagnosis.Methods Clinical data of 37 children with AAOCA were retrospectively analyzed,and clinical symptoms,myocardial enzymes,electrocardiogram and other results were summarized.The results of transthoracic echocardiography and coronary computed tomography angiography(CTA) were compared,and the characteristics of echocardiography images were evaluated to analyze the possible causes of missed diagnosis and misdiagnosis.Results This group of patients included 5 cases of anomalous origin of left coronary artery(ALCA) and 32 cases of anomalous origin of right coronary artery(ARCA),with a median age of 7 years.4(80%) children with ALCA complained of syncope or convulsions during exercise,accompanied by ST segment depression in the electrocardiogram and significant elevation of myocardial enzymes;The main complaints of 10(31%) children with ARCA were chest pain and tightness,while the others were found by chance due to other reasons.21 cases(66%) of children with ARCA were accompanied by arrhythmia.Echocardiography missed diagnosis in 2 children with ALCA(40%) and 11 children with ARCA(34%).The high rate of missed and misdiagnosis of echocardiography may be related to ultrasound artifacts,low stereo resolution,and insufficient understanding of the disease by sonographers.Conclusions To reduce the rate of missed diagnosis and misdiagnosis of AAOCA by ultrasound,combining the clinical manifestations,color Doppler and two-dimensional ultrasound information of the patients,and enhancing the awareness of exploring coronary artery opening,as well as the ability of recognizing ultrasound opening artifacts may all be helpful.

关 键 词：冠状动脉异常主动脉起源 超声心动图 儿童 诊断 

分 类 号：R725.4[医药卫生—儿科] R540.45[医药卫生—临床医学]