两腔心及合并畸形的彩色多普勒超声心动图特征研究

Color Doppler echocardiographic characteristics of bilocular heart and associated cardiac malformations

目的探寻两腔心（BH）及合并畸形的彩色多普勒超声心动图图像特征。方法超声检查20例BH，寻找BH及合并畸形的声像图特征表现，所有患者均有心血管造影对照，14例经手术证实。结果根据声像图特征表现对19例作出正确诊断，1例误诊为二尖瓣闭锁。BH及合并畸形的声像图特征明显：①二维超声心动图（2DE）心尖四腔观显示房间隔与室间隔回声全部失落，心内十字交叉消失，收缩期显示一组共同房室瓣关闭，呈“8字形”改变，称2DE“8”字征；舒张期一组共同房室瓣开向一个共同心室腔。②彩色多普勒血流显像（cDFI）舒张期均显示共同心房内血流信号通过共同房室瓣进入共同心室内；收缩期显示过共同房室瓣五彩镶嵌反流束血流信号15例。③在20例BH中，心房正位16例，心房反位4例。共同心室A型10例，B型2例，C型8例。大动脉位置关系Ⅰ型4例，Ⅱ型7例，Ⅲ型9例。肺动脉狭窄18例，肺动脉高压2例。④合并肺动脉狭窄患者CDFI于收缩期显示过肺动脉五彩镶嵌射流束血流信号。结论BH及合并畸形的声像图特征明显，其对BH及合并畸形有特异性诊断价值。

Objective To probe into the color Doppler echocardiographic characteristics of bilocular heart （BH） and associated malformations. Methods Twenty patients of BH were examined with color Doppler eehocardiography （CDE） and the characteristics were observed. All the CDE results were compared with angiocardiography and 14 were confirmed by operation. Results Nineteen cases were properly diagnosed based on the CDE characteristics, 1 case were misdiagnosed as mitral atresia. CDE characteristics of BH were obvious：（1） Apical four chamber view of two-dimensional echocardiography （2DE） showed total echo dropout in both the interatrial septum and the interventricular septum and disappearance of the intracardiac ＂cross＂. The common atrioventricular valve closed during systole and appeared as figure ＂8＂, named 2DE ＂8＂ sign. During diastole, the common atrioventricular valve opened to a common ventricle. （2） Color Doppler flow imaging （CDFI） showed common intra-atrial flow signal entereda common ventricle through common atrioventricular valve during diastole in all patients and colorful reflux through common atrioventricular valve during systole in 15 cases. （3） Among the 20 cases, 16 of the common atria were situs solitus,4 were situs inversus;10 of the common ventricles were type A,2 were type B and 8 were type C. According to the spatial relationship of the great arteries, there were 4 type Ⅰ ,7 type Ⅱ and 9 type Ⅲ. There were 18 pulmonary stenosis and 2 pulmonary hypertension. （4） In the presence of pulmonary stenosis, CDFI showed colorful shunt signals through pulmonary artery during systole. Conclusions BH and associated malformations have obvious echocardiographic characteristics. CDE has a specific value in diagnosing BH and associated malformations.