摘要
目的:探讨超声心动图对主-肺动脉间隔缺损(APSD)的诊断价值,分析超声心动图漏诊原因,旨在提高超声对APSD诊断正确率。方法:回顾性分析38例经手术、CTA或心导管造影证实为APSD患儿的临床资料,将术前超声心动图检查的声像图表现与手术、CTA或心导管造影结果对比分析,对超声漏诊及诊断不明确的声像图进行深入研究,并总结该病的超声心动图诊断要点。结果:38例患儿中,25例由外院初筛,超声心动图正确诊断11例,疑似3例,漏诊11例,漏诊率44%。本院超声心动图正确诊断30例,疑似2例,11例为单纯APSD,其余均合并其他先天心血管畸形。所有正确诊断的病例均表现为左、房室增大,主、肺动脉增宽及不同程度的肺动脉高压,其中30例显示主-肺动脉间隔的回声中断,缺损直径7～28mm。本组共漏诊6例,漏诊率15.8%,2例因同时合并室间隔缺损(VSD)、重度肺动脉高压(PH)漏诊,1例因合并右室双出口(DORV)、VSD及PH漏诊,1例因二尖瓣大量反流、PH漏诊,1例合并粗大动脉导管未闭(PDA)、PH漏诊,另1例漏诊为新生儿。结论:主-肺动脉间隔缺损临床易漏诊,出现超声心动图结果难以解释的左心增大或肺动脉高压时,首先应考虑APSD的可能,若同时合并其他心血管畸形造成的肺动脉高压时也不能完全排除APSD。并将所有怀疑为APSD的患儿同时进行心导管或CTA检查,以便早期做出正确诊断,尽早手术,改善患儿的生存率,减低死亡率。
Purpose: In order to improve the accuracy of aortopulmonary septal defect(APSD) diagnosis by echocardiography, the value of echocardiography in the diagnosis of APSD was investigated and the causes of missed diagnosis by echocardiography were analyzed. Methods: Retrospective analysis of 38 patients with operation, CTA or cardiac catheterization exam confirmed APSD was performed. The results of preoperative echocardiography and operation, CTA or cardiac catheterization results were compared. A intensive study on the echocardiography images of missed diagnosis and suspected cases was performed and the essentials of echocardiography in diagnosis of the disease was summarized. Results: Twenty-five of the 38 cases were examined in other hospitals, the diagnosisof APSD were made correctly in 11 patients and incorrectly in 14 patients with echocardiography and the missed diagnosis rate was 44%. The diagnosis of APSD was made correctly in 30 patients and incorrectly in 8 patients included 2 suspected cases with echocardiography in our hospital. Among them, 11 cases were simple APSD, others were combined with other cardiovascular malformations. All the cases were diagnosed as the enlargement of left atrial, left ventricular, the aorta and pulmonary artery, and varying degrees of pulmonary hypertension. Among them, 30 cases showed echo interruption of the aortopulmonary septal, and the diameter of the defect was 7-28 mm. A total of 6 cases of missed diagnosis in this study and the missed diagnosis rate was 15.8%. Among them, 2 cases were with concomitant ventricular septal defect(VSD) and severe pulmonary hypertension(PH),1 case was with concomitant double outlet of the right ventricle(DORV), VSD and PH, 1 case was with mitral regurgitation and PH, 1 case was with concomitant large patent duct closure(PDA) and PH, another 1 case was a newborn. Conclusion: APSD is easy to be missed diagnosis in clinical. When echocardiography is difficult to explain the left heart enlargement or pulmonary hypertension, the first consideration should be given to the possibility of APSD. APSD can not be completely excluded if the pulmonary hypertension is associated with other cardiovascular malformations. All patients who are suspected APSD should be carried out cardiac catheter or CTA examination at the same time, in order to make the correct diagnosis. The sooner the operation, the patient’s survival rate can be improved and the the mortality rate can be lowered.
作者
刘浩
朱善良
陈俊
左维嵩
莫绪明
杨明
LIU Hao;ZHU Shan-liang;CHEN Jun;ZUO Wei-song;MO Xu-ming;YANG Ming
出处
《中国医学计算机成像杂志》
CSCD
北大核心
2019年第2期186-191,共6页
Chinese Computed Medical Imaging
基金
南京医科大学附属儿童医院青苗人才项目No.ETYYQM2014027
南京医科大学科技面上项目No.2014NJMU161~~
