右心声学造影在儿童右向左分流相关疾病中的评估价值  

Value of contrast transthoracic echocardiography in assessing right-to-left shunt-related diseases in children

作　　者：陶宏宇 叶菁菁[1,2] 俞劲[1,2] 杨秀珍[1] 钱晶晶[1] 徐彬[1] 徐玮泽[2] 舒强[2] Tao Hongyu;Ye Jingjing;Yu Jin;Yang Xiuzhen;Qian Jingjing;Xu Bin;Xu Weize;Shu Qiang(Department of Ultrasonography,Children's Hospital of Zhejiang University School of Medicine,Hangzhou 310052,China;Heart Center,Children's Hospital of Zhejiang University School of Medicine,Hangzhou 310052,China)

机构地区：[1]浙江大学医学院附属儿童医院超声科,杭州310052 [2]浙江大学医学院附属儿童医院心脏中心,杭州310052

出　　处：《中华医学超声杂志(电子版)》2024年第10期959-965,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：中央引导地方科技发展资金项目(2023ZY1058)。

摘　　要：目的探讨右心声学造影(cTTE)在儿童右向左分流(RLS)相关疾病中的评估价值,为其在儿科中的规范性应用提供依据。方法回顾性收集2022年1月至2023年12月浙江大学医学院附属儿童医院单中心收治的350例怀疑存在RLS相关疾病而行cTTE检查的患儿临床资料及cTTE检查结果,分析其临床表现、cTTE对不同疾病RLS的评估结果及不良反应。结果350例行cTTE检查的患儿中男性189例,女性161例,平均年龄(10.20±2.92)岁,造影总阳性率70.86%(248/350)。共257例患儿临床诊断为卵圆孔未闭(PFO),其cTTE结果中阴性16例(16/257,6.23%),Ⅰ级分流59例(59/257,22.96%),Ⅱ级分流113例(113/257,43.97%),Ⅲ级分流69例(69/257,26.85%)。PFO患儿中50例后行经皮卵圆孔未闭封堵术,术中以经食管超声心动图检查为金标准,cTTE诊断PFO的敏感度为96%(48/50)。cTTE阳性患儿中7例为心外肺水平分流,其中肺动静脉瘘5例(4例Ⅲ级分流,1例Ⅱ级分流),Abernethy畸形合并肝肺综合征2例(Ⅲ级分流和Ⅱ级分流各1例)。共有4例(4/350,1.14%)患儿在cTTE检查后出现不同程度不良反应,以咳嗽、轻度呼吸困难为主,经吸氧及药物处理后症状均缓解。结论cTTE对儿童心内、心外不同病因引起的RLS的定性诊断及定量评估对临床诊疗有着至关重要的参考价值,在儿科领域有着广泛的应用前景。Objective To investigate the utility of contrast transthoracic echocardiography(cTTE)in the assessment of right-to-left shunt(RLS)-related diseases in pediatric patients,aiming to establish standardized guidelines for its application in pediatrics.Methods From January 2022 to December 2023,the clinical data and cTTE results of 350 pediatric patients suspected of having RLS-related diseases and who underwent cTTE at the Children's Hospital,Zhejiang University School of Medicine were retrospectively collected.The clinical manifestations and cTTE evaluation results for different RLS-associated conditions,as well as adverse reactions of cTTE,were analyzed.Results A cohort of 350 pediatric patients underwent cTTE examination,comprising 189 males and 161 females,with a mean age of(10.20±2.92)years.The overall positivity rate was determined to be 70.86%(248/350).A total of 257 children were clinically diagnosed with patent foramen ovale(PFO).Among them,16 cases(16/257,6.23%)had negative cTTE results,59(59/257,22.96%)had grade Ⅰ shunt,113(113/257,43.97%)had grade Ⅱ shunt,and 69(69/257,26.85%)had grade Ⅲ shunt.Fifty PFO patients underwent percutaneous closure of patent foramen ovale.Using transesophageal echocardiography(TEE)as the gold standard,the sensitivity of cTTE for diagnosing PFO was 96%(48/50).There were 7 cases of extracardiac pulmonary shunt,including 5 cases of pulmonary arteriovenous fistula(4 cases of grade Ⅲ shunt and 1 case of grade Ⅱ shunt)and 2 cases of Abernethy malformation with hepatopulmonary syndrome(1 case of grade Ⅲ shunt and 1 case of grade Ⅱ shunt).There were 7 cases of extracardiac pulmonary shunt,including 5 cases of pulmonary arteriovenous fistula(4 cases of grade Ⅲ shunt and 1 case of grade Ⅱ shunt)and 2 cases of Abernethy malformation with hepatopulmonary syndrome(1 case of grade Ⅲ shunt and 1 case of grade Ⅱ shunt).A total of 4 cases(4/350,1.14%)had different degrees of adverse reactions after cTTE examination,mainly cough and mild dyspnea,which were relieved after o

关 键 词：右心声学造影 儿童 卵圆孔未闭 肺动静脉瘘 右向左分流 

分 类 号：R72[医药卫生—儿科]