术前经胸超声心动图诊断主动脉右冠状动脉窦瘤破裂经室间隔缺损突入右室流出道与术中对照

发布时间：2018-07-31 11:19

【摘要】：目的:探讨术前主动脉右冠状动脉窦瘤破裂经室间隔缺损突入右室流出道的经胸超声心动图诊断和鉴别诊断。方法:回顾2010年2月至2016年9月在湘雅二医院及湘雅医学院附属海口医院术前经胸超声心动图诊断主动脉右冠状动脉窦瘤破裂经室间隔缺损突入右室流出道的患者19例,对照分析患者临床症状、超声心动图和术中病变发现。结果:术中病变发现16例符合术前超声心动图诊断,其中11例胸骨左缘2~3肋听诊可闻及连续性机器样杂音,伴有收缩期震颤,彩色多普勒显像右心室侧探及收缩期为主的连续性血流频谱,术前超声心动图及术中病变证实室间隔缺损位置大小及右窦瘤破裂经室间隔缺损口突入右室流出道;其中3例还合并其他复杂心脏病。3例与术前诊断不符合,听诊闻及杂音,不伴有震颤;术前超声心动图及术中病变发现右窦瘤破裂口大、冗长,其中1例合并主动脉瓣狭窄并关闭不全、先天主动脉瓣二瓣化畸形,1例合并主动脉瓣中-重度反流,1例合并肺部感染,3例术中病变都未发现室间隔缺损。结论:术前经胸超声心动图诊断右窦瘤破裂经室间隔缺损突入右室流出道是术前首选、快捷和无创的检查方法,采用超声心动图各阶段观察程序与方法能较好地观察主动脉窦瘤破裂及室间隔缺损的位置、形态大小、毗连关系和是否合并其他心脏疾病,通过超声多普勒显像能发现右窦瘤破裂经室间隔缺损突入右室流出道的血流频谱特征。
[Abstract]:Objective: to investigate the transthoracic echocardiographic diagnosis and differential diagnosis of ruptured aortic right coronary sinus aneurysm (RCA) through ventricular septal defect (VSD) into right ventricular outflow (RVF) before operation. Methods: from February 2010 to September 2016, 19 patients with ruptured aneurysm of right coronary sinus into right ventricular outflow were diagnosed by transthoracic echocardiography in Xiangya second Hospital and Haikou Hospital of Xiangya Medical College. Clinical symptoms, echocardiography and intraoperative lesions were compared and analyzed. Results: 16 cases of intraoperative pathological changes were found to be in accordance with preoperative echocardiographic diagnosis. Among them, 11 cases with systolic tremor were found to be audible and continuous machine-like murmur by auscultation on the left side of sternum. Color Doppler imaging showed continuous flow spectrum of right ventricular lateral exploration and systolic phase. The location of ventricular septal defect was confirmed by preoperative echocardiography and intraoperative lesions, and the rupture of right sinus tumor through the orifice of ventricular septal defect into the right ventricular outflow tract. Among them, 3 cases with other complicated heart diseases were not in accordance with preoperative diagnosis, auscultation and murmur were not accompanied by tremor, preoperative echocardiography and intraoperative lesions revealed that the ruptured orifice of right sinus aneurysm was large and long. One patient with aortic valve stenosis and insufficiency, one with congenital aortic valve bivalvular malformation, one with moderate to severe aortic valve reflux, one with pulmonary infection and no ventricular septal defect. Conclusion: preoperative transthoracic echocardiography in diagnosis of ruptured right sinus aneurysm through ventricular septal defect into the right ventricular outflow tract is the first choice, rapid and non-invasive examination method. The location, size, contiguity and association of aortic sinus aneurysm and ventricular septal defect (VSD) were observed by echocardiographic procedures and methods. The flow spectrum of right sinus aneurysm ruptured through ventricular septal defect (VSD) into the right ventricular outflow (RVF) can be found by ultrasound Doppler imaging.
【作者单位】：中南大学湘雅二医院心血管外科;中南大学湘雅医学院附属海口医院;
【基金】：海南省自然科学基金(20168318)~~
【分类号】：R541.1

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