儿童先天性右心房畸形的超声心动图诊断价值及漏误诊分析

The diagnostic value and misdiagnostic analysis of congenital malformations of the right atrium in children by Doppler echocardiography

目的 探讨彩色多普勒超声心动图对儿童先天性右心房畸形(congenital malformations of the right atrium, CMRA)的诊断价值,分析漏诊与误诊原因,提高超声心动图对儿童CMRA的首次检出率。方法 选取并分析22例经手术与MRI及CT诊断为CMRA的患儿资料,其中11例行胸外科手术治疗。结果 本组原发性右心房扩张15例、右心房憩室3例、原发性右心耳扩张3例、冠状静脉窦憩室1例。单纯性CMRA患儿10例,合并畸形12例,包括卵圆孔未闭5例、房间隔缺损4例、三尖瓣轻-中度反流3例、三尖瓣发育不良1例、三尖瓣重度反流1例;7例合并阵发性室上性心动过速等严重的心律失常。22例超声诊断正确18例(81.8%);漏诊与误诊4例(18.2%),其中误诊3例,漏诊1例;1例右心房憩室误诊为原发性右心房扩张,1例原发性右心房扩张误诊为原发性右心耳扩张,1例冠状静脉窦憩室误诊为冠状静脉窦狭窄,1例原发性右心房扩张漏诊。结论 彩色多普勒超声心动图可以比较准确地诊断儿童CMRA,但容易漏、误诊。

Objective To assess the diagnostic value of children with congenital malformations of the right atrium(CMRA) by Color Doppler echocardiography, and to analyze the missed and misdiagnosis reasons to improve the first detection rate of CMRA in children. Methods Echocardiography data of 22 childrens diagnosed with CMRA by operation, MRI and CT were retrospectively analyzed, eleven of them underwent thoracic surgery. Results CMRA consisted of idiopathic dilation of the right atrium(15 cases),congenital diverticulum of the right atrium(3 cases), idiopathic dilation of the right heart appendage(3 cases), and congenital diverticulum of the coronary sinus(1 case). There were simple CMRA(10 cases), and the associated malformations included patent foramen ovale(5 cases),atrial septal defect(4 cases), mild-to-moderate tricuspid valve regurgitation(3 cases),hypoplastic tricuspid valve(1 case), and severe tricuspid regurgitation(1 case). Seven cases had severe arrhythmias such as paroxysmal supraventricular tachycardia. Eighteen of 22 cases were diagnosed correctly, and other 4 cases were be missed or be misdiagnosed, in which 1 case of right atrial diverticulum was misdiagnosed as primary right atrial dilatation, 1 case of primary right atrial dilatation was misdiagnosed as congenital enlargement of the right atrial appendage, 1 case of congenital diverticulum of the coronary sinus was misdiagnosed as coronary sinus stenosis, and 1 case with idiopathic dilation of the right atrium was missed. Conclusion Various lesions of children CMRA could be diagnosed by color Doppler echocardiography, but it is easy to be missed or misdiagnosed.