复杂先心病合并体静脉畸形的二维及彩色多普勒超声诊断  

Diagnosis of Systemic Venous Anomaly in Complicated Conge nital Heart Disease with Two-dimensional and Color Dopplar Ultrasound

作　　者：耿斌[1] 李晓丹[2] 丁文虹[1] 张桂珍[1] 韩玲[1] 李永青[1] 郑春华[1] 

机构地区：[1]首都医科大学附属北京安贞医院心儿科,北京市100029 [2]四平市中心医院电诊科,吉林省

出　　处：《中国超声医学杂志》2004年第1期20-25,共6页Chinese Journal of Ultrasound in Medicine

摘　　要：目的 :探讨复杂先天性心脏病合并常见体静脉畸形的超声特征 ,以便做出正确的诊断。方法 :与结果 :本文报道经二维和彩色多普勒诊断并经造影或手术证实 69例复杂先天性心脏病合并体静脉畸形引流 ,其中部分患者为多发静脉畸形 ;69例中合并静脉畸形 77例次 ,包括永存左上腔静脉 (L SVC) 47例次 ;左上腔静脉入左房 15例次 ;合并奇静脉异常连接的下腔静脉 (IVC)肾上段中断 10例次和严重狭窄 1例 ;左无名静脉走行异常 4例次。结论 :1.心房异构时 ,体静脉畸形发生率显著高于心房正位 ,且异构的性质与体静脉畸形引流类型密切相关 ;2 .为了正确诊断体静脉畸形引流 ,应进行多切面系统检查 ,尤其注意对剑下、胸骨上窝和胸骨旁高位切面的观察 ;3 .剑下短轴切面见腹主动脉/下腔静脉与脊柱的对称关系消失 ,则提示下腔静脉异常 ;左胸骨旁高位与胸骨上窝切面多能直接显示左上腔静脉 ,同时左无名静脉非常细小或缺如。如果冠状静脉窦无扩张 ,则高度怀疑左上腔静脉入左房。左上肢静脉声学造影对左上腔静脉畸形的识别有重要意义。Objective:To study the specific ultraso nic features of anomalous systemic venous drainage in complicated congenital hea rt diseases for making accurate diagnosis Methods:All the cases(69) were diagnosised by two dimensional and color Doppler flow imaging,and confirmed by angiography or operation Results:Some patients were with multiple venous anomalies Amo ng 69 patients,47 cases with persistent left superior vena cava (LSVC)to coron ary sinus(CS);15 cases with abnormal drainage of LSVC to left atrium;10 cases with interrupted suprarenal portion of inferior vena cava(IVC),1 case with sev ere IVC stenosis associated with azygos continuating to infrarenal IVC;and 4 cas es with abnormal course of left innominate vein Conclusions:1 The atrial isomerism carries a high rate of ano malous systemic venous return and correlates with the types of systemic venous a bnormality 2 In order to recognize anomalous systemic venous return,particular attention should be paid to subcostal,suprasternal and left high precardial sca ns 3 Normally,abdominal aorta and IVC symmetrically locate on each side of the vertebral column.Loss of the symmetry in short subcostal axis area suggests the possibility of IVC anomaly.If dual SVC exist without CS dilation,anomalous drai nage of LSVC to left atrium is highly suspected Furthermore,contrast echocardio graphy is of great value in identifying LSVC abnormalities

关 键 词：合并症 体静脉畸形 二维超声 彩色多普勒超声 影像学诊断 复杂先天性心脏病 心房异构 

分 类 号：R445.1[医药卫生—影像医学与核医学]