儿童三房心畸形的超声心动图诊断价值及漏误诊分析  

The diagnostic value and misdiagnostic analysis of cor triatriatum sinistrum in children by Doppler echocardiography

作　　者：鲁秀莉 刘贻曼 陈丽君[2] 张玉奇[2] 赵琳琳 LU Xiuli;LIU Yiman;CHEN Lijun;ZHANG Yuqi;ZHAO Linlin(Department of Ultrasound,Jiaxing xiuzhou District Maternal and Child Health Hospital,Jiaxing 314031,China;Department of Pediatric Cardiology,Shanghai Children’s Medical Center,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)

机构地区：[1]浙江省嘉兴市秀洲区妇幼保健院超声科,浙江嘉兴314031 [2]上海交通大学医学院附属上海儿童医学中心心内科,上海200127

出　　处：《医学影像学杂志》2024年第11期40-42,47,共4页Journal of Medical Imaging

基　　金：国家自然科学基金青年科学基金项目(编号:82001835)。

摘　　要：目的探讨彩色多普勒超声心动图对儿童三房心(cor triatriatum sinistrum,CTS)畸形的诊断价值,分析漏诊误诊原因。方法选取36例超声心动图诊断为CTS的患儿资料,分析彩色多普勒超声心动图表现特征,其中26例经胸外科手术证实。结果26例经胸外科手术证实患者中2例为单纯性,24例合并其它心血管畸形。常见的有房间隔缺损19例、肺动脉高压16例、三尖瓣轻-中度反流6例、卵圆孔未闭3例、室间隔缺损3例、部分性肺静脉异位引流3例。二维超声心动图在剑下双房心切面、心尖四腔切面和胸骨旁大动脉短轴切面均可显示左心房内异常隔膜样组织,彩色多普勒超声显示副房经隔膜到真房腔的彩色血流。26例手术患儿超声诊断符合24例;漏误诊2例,其中1例误诊为华法林嵴,1例三房心漏诊。26例患者行左心房内隔膜切除术,手术前隔膜处最大峰值流速为(2.15±0.43)m/s,术后过隔膜处流速为(0.85±0.22)m/s,二者间差异有统计学意义(P<0.05)。本组10例未手术的CTS患儿经超声检查随访2年以上,隔膜处流速均小于1.6 m/s,差异无统计学意义(P>0.05)。结论彩色多普勒超声心动图可以比较准确的诊断CTS,但容易漏误诊,需与先天性二尖瓣瓣上环、华法林嵴等鉴别,CTS外科手术效果良好。Objective To investigate the diagnostic value of color Doppler echocardiography for cor triatriatum sinistrum(CTS)in children,and analyze the misdiagnosed reason to improve the correct rate of diagnosis in the future.Methods Thirtysix children with CTS diagnosed by echocardiography were retrospectively to,echocardiographic images were compared with surgical findings in 26 patients.Results Among the 26 CTS confirmed by surgical operation,2 cases were the simple CTS,19 cases were associated malformations included atrial septal defect,6 cases were mild-to-moderate tricuspid valve regurgitation,16 cases were pulmonary hypertension,3 cases were patent foramen ovale,3 cases were ventricular septal defect,and 3 cases were partial anomalous pulmonary venous connection.Two-dimensional echocardiography shows showed abnormal membrane-like tissue in the left atrium in the subcostal sagittal view of the atrium septum,apical four-chamber view,and parasternal long-axis view of the left ventricle,color Doppler echocardiography revealed color flow signals through membranel-like tissue from the accessory chamber to the true left atrium.In 26 operated children,24 cases were diagnosed correctly,1 case was misdiagnosed as coumadin ridge,1 case was missed.The abnormal membrane-like tissue was resected in 26 children,the maximum velocity originating proxinal to membrane decreased from(2.15±0.43)m/s to(0.85±0.22)m/s(P<0.05).In 10 children with unoperated CTS followed up more than 2 years,there was no significant increase in flow velocity through membrane-like tissue,and the flow velocities were all less than 1.6 m/s(P>0.05).Conclusions CTS could be diagnosed accurately by Color Doppler echocardiography,but it is prone to be missed and misdiagnosed,and needs to be differentiated from congenital supravalvular mitral ring and coumadin ridge.The outcome of surgical correction of the CTS is good.

关 键 词：彩色多普勒 超声心动图 三房心 

分 类 号：R725.4[医药卫生—儿科] R445.1[医药卫生—临床医学]