心下型完全性肺静脉异位连接的超声心动图诊断

发布时间：2018-03-18 19:24

本文选题：超声心动图　切入点：心血管畸形　出处：《北京大学学报(医学版)》2017年05期 　论文类型：期刊论文

【摘要】：目的:评价超声心动图对婴幼儿心下型完全性肺静脉异位连接的诊断价值。方法:回顾性分析2006年4月至2016年12月经超声心动图诊断的8例心下型完全性肺静脉异位连接患儿,其中男4例、女4例,年龄15~195d,平均年龄79.8 d。超声从胸骨旁、剑突下、心尖多个切面,观察肺静脉异位引流的途径及位置,右心房、右心室的扩大程度,心房水平分流方向等。结果:8例心下型完全性肺静脉异位连接患儿中,6例行CT检查,5例行手术治疗。超声心动图检出7例,漏诊1例,诊断准确率为87.5%。本病的间接超声征象为小的畸形左心房和心房水平右向左分流,肝、门静脉扩张迂曲,肝内血流丰富;直接征象为左、右肺静脉未回流左心房,汇成共同肺静脉干,汇入垂直静脉后经右下行穿越膈肌至门静脉或肝静脉。剑突下切面可显示3条平行走行的血管,即垂直静脉、腹主动脉和下腔静脉,前二者与后者血流方向相反。8例患儿垂直静脉膈下回流部位均为门静脉,3例患儿存在降垂直静脉与门静脉或肝静脉连接处梗阻。结论:超声心动图对诊断小儿心下型完全性肺静脉异位连接具有重要价值,能为外科术前评估提供结构及血流动力学信息。采用多声窗、多切面及连续追踪法观察心下型完全性肺静脉异位连接异位引流的肺静脉行程,可对其作出准确诊断,但须与混合型肺静脉异位引流及肝内门-体静脉分流或肝动脉-静脉瘘等疾病相鉴别。
[Abstract]:Objective: to evaluate the value of echocardiography in the diagnosis of infantile subcardiac complete pulmonary venous ectopic connection. Methods: eight cases of infantile subcardiac complete pulmonary venous ectopic connection diagnosed by echocardiography from April 2006 to 2016 were analyzed retrospectively. There were 4 males and 4 females with an average age of 79.8 d. Ultrasound was used to observe the way and location of anomalous pulmonary venous drainage, the degree of enlargement of right atrium and right ventricle from the sternal side, under the xiphoid process and at the apex of the heart. Results in 8 cases of subcardiac complete pulmonary venous ectopic connection, 6 cases underwent CT examination and 5 cases were treated surgically, 7 cases were detected by echocardiography, 1 case was missed diagnosis. The diagnostic accuracy was 87.5%. The signs of indirect ultrasound were left atrium and left atrial shunt, liver and portal vein dilated and tortuous, blood flow was abundant in liver, direct sign was left, right pulmonary vein did not return to left atrium, right pulmonary vein did not return to left atrium, right pulmonary vein did not return to left atrium, right pulmonary vein did not return to left atrium. Converging into the common pulmonary vein trunk, flowing into the vertical vein through the lower right diaphragm to the portal vein or hepatic vein. The inferior facet of the sword process shows three parallel vessels, namely, the vertical vein, the abdominal aorta, and the inferior vena cava. The former two were opposite to the latter in the direction of blood flow. The subphrenic circumfluence of the vertical veins in all cases was portal vein obstruction in 3 cases. Conclusion: echocardiography is useful in diagnosis of children's heart with the presence of obstruction at the junction of vertical vein and portal vein or hepatic vein. The subtotal pulmonary venous ectopic connection is of great value. It can provide the information of structure and hemodynamics for preoperative evaluation of surgery. Using multi-sound window, multi-section plane and continuous tracing method, we can observe the itinerary of pulmonary vein with complete anomalous connection of pulmonary vein and ectopic drainage of subcardiac type, and make an accurate diagnosis of it. But it should be distinguished from mixed pulmonary venous ectopic drainage and portal venous shunt or hepatic arterial-venous fistula.
【作者单位】：泰达国际心血管病医院超声科;
【分类号】：R540.45;R725.4

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