复杂型先天性心脏病大型主—肺动脉侧支血管的形态学特征

发布时间：2018-07-01 16:12

本文选题：心脏缺损 + 先天性　；参考：《广州医科大学》2014年硕士论文

【摘要】：目的探讨复杂型先天性心脏病（先心病）患儿大型主-肺动脉侧支血管（majoraortopulmonary collateral arteries, MAPCAs）的形态学特征。方法回顾性分析伴MAPCAs的复杂型先心病患儿的MAPCAs的影像学资料，总结MAPCAs发布规律、数量及形态学特征。结果本组伴MAPCAs的复杂型先心病患儿51例，其中肺动脉闭锁/室间隔缺损33例（64.71%），法洛四联症11例（21.57%），右室双出口2例（3.92%），完全性大动脉转位1例（1.96%），完全性房室间隔缺损1例（1.96%），肺动脉狭窄1例（1.96%），肺动脉吊带1例（1.96%），肺动脉缺如1例（1.96%）。另外，合并动脉导管未闭16例（31.37%）。本组51例中存在中央共汇43例（84.31%），MAPCAs共117支，每例约1~6支，平均2.29支。MAPCAs起始直径为2.0~18.0mm，平均约4.3mm。MAPCAs起源于主动脉弓16支（13.68%），胸降主动脉75支（64.10%），头臂干2支（1.71%），右锁骨下动脉11支（9.40%），左锁骨下动脉12支（10.26%），其他1支（0.85％）。本组有3支（2.56%）MAPCAs开口出现狭窄及狭窄后扩张，，57支（48.72%）MAPCAs在进入肺脏前出现迂回、扭曲状，8例（15.69%）患儿MAPCAs为唯一血源供应相应肺段。另有13支（11例，均为肺动脉闭锁/室间隔缺损）较粗大的MAPCAs可见分支，其分支为2~4支，多为2支。根据Rabinovitch等对MAPCAs的分型，可见本组病例中，Ⅱ型有91支(77.78%)，Ⅲ型有26支(22.22%)，未见Ⅰ型。结论MAPCAs多见于某些肺血减少型先心病，且分布较广泛，其起源、数量、大小、走向以及分支等方面变异较大，主要影响手术方式选择及疗效，了解MAPCAs的分布规律及形态学特征具有十分重要的临床意义。
[Abstract]:Objective to investigate the morphological characteristics of majoraortopulmonary collateral arteries (MAPCAs) in children with complex congenital heart disease (congenital heart disease). Methods the imaging data of MAPCAs in children with complex congenital heart disease with MAPCAs were retrospectively analyzed, and the regularity of MAPCAs publication, quantitative and morphological characteristics were summarized. There were 51 children with complex congenital heart disease with MAPCAs, including 33 cases of pulmonary atresia / ventricular septal defect (64.71%), 11 (21.57%) tetralogy of Fallot, 2 right ventricle double exit (3.92%), 1 complete transposition of the large artery (1.96%), 1 cases of complete atrioventricular septal defect (1.96%), pulmonary artery stenosis 1 (1.96%), pulmonary artery sling in 1 cases, pulmonary artery absent In addition, 16 cases (31.37%) were combined with patent ductus arteriosus (31.37%). In this group, there were 43 cases of Central Co remittance (84.31%), 117 MAPCAs, each 1~6 branch, and the average initial diameter of 2.29.MAPCAs was 2.0~18.0mm. The average about 4.3mm.MAPCAs originated from the 16 branch of the aortic arch (13.68%), the thoracic aorta 75 (64.10%), the cephalosbrachial 2 branches (1.71%), and right clavicle. 11 arteries (9.40%), 12 branches of left subclavian artery (10.26%) and 1 (0.85%). 3 (2.56%) MAPCAs openings were narrowed and dilated after stenosis. 57 (48.72%) MAPCAs appeared to be tortuous and twisted before entering the lungs. In 8 (15.69%) children, MAPCAs served as the sole source of the pulmonary artery. Another 13 (all were pulmonary atresia / interventricular). Septal defect) a larger branch of MAPCAs, with a branch of 2~4 branch and more than 2 branches. According to the classification of MAPCAs by Rabinovitch, there are 91 (77.78%), 26 (22.22%) type of type II in this group, and no type I. Conclusion MAPCAs is mostly found in certain pulmonary blood reduction type of congenital heart disease and is widely distributed, its origin, quantity, size, trend and trend. The variation of branches and other factors mainly affect the choice and curative effect of operation. It is of great clinical significance to understand the distribution and morphological characteristics of MAPCAs.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725.4

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