婴幼儿圆锥动脉干畸形型先天性心脏病合并冠状动脉异位起源的MSCT诊断

发布时间：2019-04-23 07:37

【摘要】：目的:研究圆锥动脉干畸形型先天性心脏病合并冠状动脉异位起源的类型、发生率、构成比,探讨术前MSCT心脏成像诊断对术前计划制定的重要性。方法:回顾性分析276例经手术证实的圆锥动脉干畸形型先天性心脏病,所有患儿均在本院行MSCT心脏成像,并记录先天性心脏病类型、冠状动脉异位起源的类型及数量。对不同类型先天性心脏病的冠状动脉异位起源的发生率采用行×列Person卡方检验进行比较,对不同先天性心脏病的冠状动脉异位起源构成比采用Fisher确切概率法进行比较。与手术结果对照,探讨术前MSCT心脏成像诊断对术前计划制定的重要性。结果:圆锥动脉干畸形型先天性心脏病共276例,合并冠状动脉异位起源者47例,平均发病率为17%,其中肺动脉闭锁PA 11例,大动脉转位TGA 15例,法洛氏四联症TOF 4例,永存动脉干PTA 6例,右室双出口DORV 11例。在本组圆锥动脉干畸形型先天性心脏病伴发冠状动脉异位起源中,单冠状动脉SCA最多,占48.94%,其次为对侧冠状动脉或无冠窦起源OO,占29.79%,冠状动脉多发起源MO占14.89%,冠状动脉高位起源HO为4.26%,冠状动脉肺动脉起源PO最少,占2.13%。Fisher确切概率法比较,卡方值为15.452,P值为0.472,说明不同类型先天性心脏病的冠状动脉异位起源构成比差异无统计学意义,可以认为不同类型先天性心脏病的冠状动脉异位起源构成比不全相同,与圆锥动脉干畸形的严重程度相关。本研究冠状动脉异位起源发生率由高到低依次为PTA(35.3%)TGA(27.3%)DORV(25%)PA(16.9%)TOF(4.2%)。但是TGA的构成比高达32%。结论:不同类型圆锥动脉干畸形型先天性心脏病合并冠状动脉异位起源的发生率及构成比不同,与圆锥动脉干畸形的严重程度相关;我们应该更多地关注大动脉转位伴发冠状动脉异位起源的患儿。
[Abstract]:Aim: to study the types, incidence and composition ratio of congenital heart disease complicated with coronary artery ectopic origin in conic artery trunk malformation, and to explore the importance of preoperative MSCT cardiac imaging diagnosis in preoperative planning. Methods: MSCT cardiography was performed in 276 children with congenital heart disease proved by operation. The types of congenital heart disease, the type and quantity of anomalous origin of coronary artery were recorded. The incidence of heterotopic origin of coronary artery in different types of congenital heart disease was compared by X-ray Person Chi-square test, and the composition ratio of heterotopic origin of coronary artery in different congenital heart disease was compared by Fisher exact probability method. Compared with the results of operation, the importance of preoperative MSCT cardiac imaging in preoperative planning was discussed. Results: there were 276 cases of conic artery trunk malformation congenital heart disease, 47 cases complicated with heterotopic origin of coronary artery, the average incidence was 17%, 11 cases of pulmonary atresia PA, 15 cases of transposition of great artery, 4 cases of TOF of tetralogy of Fallot, 11 cases of pulmonary atresia, 15 cases of transposition of great artery, 4 cases of TOF. There were 6 cases of persistent arterial trunk PTA and 11 cases of right ventricular double outlet DORV. In this group, single coronary artery SCA (48.94%) was the highest, followed by contralateral coronary artery or non-coronary sinus origin OO, (29.79%). The MO of multiple origin of coronary artery was 14.89%, the HO of high origin of coronary artery was 4.26%, the PO of origin of coronary artery and pulmonary artery was the least, the exact probability of 2.13%.Fisher was 15.452, P value was 0.472, The results showed that there was no significant difference in the composition ratio of the heterotopic origin of coronary artery between different types of congenital heart disease, and that the composition ratio of the heterotopic origin of coronary artery in different types of congenital heart disease was not all the same. It is related to the severity of conus arteriosus malformations. The incidence of coronary heterotopic origin was PTA (35.3%) TGA (27.3%) DORV (25%) PA (16.9%) TOF (4.2%). But TGA has a composition ratio of 32%. Conclusion: the incidence and composition of different types of congenital heart disease complicated with coronary artery heterotopic origin are different, which is related to the severity of Cone artery trunk malformation. We should pay more attention to children with transposition of the great artery with heterotopic origin of coronary artery.
【作者单位】：广州白云区人民医院放射科广东省妇幼保健院放射科广州医科大学附属第一医院放射科
【分类号】：R725.4;R816.92

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