主肺动脉间隔缺损的超声心动图诊断价值及漏误诊分析
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摘要
目的探讨多普勒超声心动图对主肺动脉间隔缺损(aortopulmonary septal defect,APSD)的诊断价值,分析漏诊、误诊原因,提高超声心动图对APSD诊断的准确性。方法回顾性分析60例经心外科手术或CT检查诊断为APSD患儿的超声心动图资料。结果 APSD的声像图特征主要表现为:主肺动脉间隔存在缺损、双向分流及肺动脉高压。本组单纯性APSD 17例,合并其它心脏畸形者43例(71. 7%);常见的合并畸形有右肺动脉异常起源于升主动脉16例、主动脉弓中断或主动脉缩窄13例、室间隔缺损9例、房间隔缺损/卵圆孔未闭9例、动脉导管未闭7例、肺动脉闭锁伴室间隔缺损1例。Mori分型Ⅰ型15例,Ⅱ型42例,Ⅲ型3例。超声心动图诊断正确55例(91. 7%);漏、误诊5例(8. 3%),其中漏诊3例(5. 0%),误诊2例(3. 3%)。结论彩色多普勒超声心动图可以比较准确地诊断主肺动脉间隔缺损。
Objective To assess the diagnostic value of aortopulmonary septal defect( APSD) by Doppler echocardiography,and to analyze the misdiagnosis reasons to improve the correct rate of diagnosis in the future. Methods Doppler echocardiographywas performed and this imaging was compared with operative or CT findings in 60 children with APSD. Results APSD was char-acterized by the presence of the"T"artifact and bidirection shunt at the margins of APSD,and pulmonary artery hypertension.The associated malformations included anomalous origin of right pulmonary artery from the ascending aorta( 16 cases),interruptedaortic arch/coarctation of the aorta( 13 cases),atrial septal defect/patent foramen ovale( 9 cases),ventricular septal defect( 9 cases),patent ductus arteriosus( 7 cases),and pulmonary atresia with ventricular septal defect( 1 case). TypeⅠ included15 cases,typeⅡ 42 cases,and type Ⅲ 3 cases. 55 cases( 91. 7%) were diagnosed correctly,5 cases( 8. 3%) were misdiag-nosed. In misdiagnosed cases,3 cases were missed diagnosis,2 cases were misdiagnosed. Conclusion APSD could be diagnosed accurately by Doppler echocardiography.
Objective To assess the diagnostic value of aortopulmonary septal defect( APSD) by Doppler echocardiography,and to analyze the misdiagnosis reasons to improve the correct rate of diagnosis in the future. Methods Doppler echocardiographywas performed and this imaging was compared with operative or CT findings in 60 children with APSD. Results APSD was char-acterized by the presence of the"T"artifact and bidirection shunt at the margins of APSD,and pulmonary artery hypertension.The associated malformations included anomalous origin of right pulmonary artery from the ascending aorta( 16 cases),interruptedaortic arch/coarctation of the aorta( 13 cases),atrial septal defect/patent foramen ovale( 9 cases),ventricular septal defect( 9 cases),patent ductus arteriosus( 7 cases),and pulmonary atresia with ventricular septal defect( 1 case). TypeⅠ included15 cases,typeⅡ 42 cases,and type Ⅲ 3 cases. 55 cases( 91. 7%) were diagnosed correctly,5 cases( 8. 3%) were misdiag-nosed. In misdiagnosed cases,3 cases were missed diagnosis,2 cases were misdiagnosed. Conclusion APSD could be diagnosed accurately by Doppler echocardiography.
引文
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[9]吴力军,张玉奇,孙锟,等. Berry综合征的超声心动图诊断价值分析[J].医学影像学杂志,2014,24(11):1887-1891
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[2]贺新建,董凤群,董彦清.超声心动图诊断主肺动脉间隔缺损的价值[J].中国超声医学杂志,2012,28(9):820-823.
[3] Louis-Jacques AF,Obian SG,Nguyen T,et al. Prenatal diagno-sis of aortopulmonary window associated with aberrant subclavianartery[J]. Cardiol Young,2017,27(7):1441-1443.
[4] Talwar S,Agarwal P,Choudhary SK,et al. Aortopulmonarywindow:Morphology,diagnosis,and long-term results[J]. JCard Surg,2017,32(2):138-144
[5] Demir IH,Erdem A,Saritas T,et al. Diagnosis,treatment andoutcomes of patients with aortopulmonary window[J]. BalkanMed J,2013,30(2):191-196.
[6] Kiran VS,Singh MK,Shah S,et al. Lessons learned from a se-ries of patients with missed aortopulmonary windows[J]. CardiolYoung,2008,18(5):480-484.
[7]沈蓉,孙锟,张玉奇.多普勒超声心动图诊断主肺动脉间隔缺损[J].中国医学影像技术,2002,18(1):46-48.
[8] Awasthy N,Shrivastav S,Iyer KS. Aortopulmonary window withpulmonary atresia:a very rare association[J]. Pediatr Cardiol,2013,34(4):1052-1054.
[9]吴力军,张玉奇,孙锟,等. Berry综合征的超声心动图诊断价值分析[J].医学影像学杂志,2014,24(11):1887-1891
[10] Singh J,Loona M,Suryavanshi A,et al. Aortopulmonary win-dow with anomalous coronary arteries[J]. J Card Surg,2015,30(11):846-848