中老年动脉导管未闭彩色多普勒超声心动图特征和规律性研究

Study on the characteristics and regularity of patent ductus ateriosus in patients over 40 years old on color Doppler echocardiography

目的:探讨中老年动脉导管未闭(PDA)彩色多普勒超声心动图(CDE)特征和规律性。方法:应用CDE检查155例中老年PDA,寻找CDE特征和规律性,所有病例均经心血管造影对照,并行经皮穿刺PDA封堵术介入治疗。用彩色多普勒血流显像(CDFI)估测PDA肺动脉端直径与心血管造影测量PDA肺动脉端直径进行统计学相关检验,观察CDFI估测中老年PDA直径的准确性。结果:根据CDE特征对所有中老年PDA患者全部做出正确诊断,中老年PDA的CDE特征和规律性明显:①M型超声和二维超声心动图显示左心房(93.5%)、左心室(51.6%)内径不同程度增大,室间隔与左室后壁运动幅度增大;②所有患者CDFI均显示过动脉导管左向右五彩镶嵌分流束血流信号;③根据CDFI测量PDA肺动脉端分流束血流信号宽度判断PDA肺动脉端直径与心血管造影对照,二者呈显著正相关(r=0.73,P<0.001);④中老年PDA合并心脏瓣膜关闭不全明显增多,其中二尖瓣关闭不全(78.7%)、主动脉瓣关闭不全(61.3%)、三尖瓣关闭不全(34.8%)、肺动脉瓣关闭不全(30.3%);⑤中老年PDA合并肺动脉高压明显增多(46.5%);⑥中老年PDA患者女性(83.9%)明显多于男性(16.1%)。结论:中老年PDA的CDE特征和规律性明显,CDE对中老年PDA有特异性诊断价值。

Objective:To explore the image characteristics and regularity of patent ductus arteriosus(PDA) in patients over 40 years old with color Doppler echocardiography(CDE).Methods:155 patients over 40 years old with PDA were examined with CDE to find out the image characteristics and regularity.All cases underwent cardiac angiography,and were confirmed by percutaneous PDA occlusion therapy.The diameter of PDA on the side of pulmonary artery measured by color Doppler flow image(CDFI) was compared with cardiac angiography results.By statistic analysis,we study the accuracy of CDE on the measurement of the size of PDA.Results:All cases were accurately diagnosed by CDE.The image features of PDA were obvious.① M-mode echocardiography and two-dimensional echocardiography showed enlarged left atrium(93.5%) and left ventricle(51.6%).The movement of ventricular septum and left ventricular post-wall increased;② CDFI showed colorful shunt signals through PDA;③ the diameter of the shunt signal on the side of pulmonary artery accessed by CDFI is highly related with those measured under cardiac angiography(r=0.73,P<0.001);④ PDA combined with cardiac valve insufficiency increased obviously among patients over 40 years old,mitral insufficiency(78.7%),aortic insufficiency(61.3%),tricuspid insufficiency(34.8%) and pulmonary insufficiency(30.3%);⑤ PDA combined with pulmonary arterial hypertension(46.5%) increased obviously among patients over 40 years old;⑥ The incidence rate of PDA over 40 years old much higher in female(83.9%) than in male(16.1%).Conclusion:The image feature of PDA by CDE among patients over 40 years old was obvious.CDE was of great value in diagnosing PDA especially among patients over 40 years old.