继发孔房间隔缺损与全肺静脉异位引流的心电图和血流动力学比较

Comparison of Electrocardiogram and HemdynamicsBetween Secundum Atrial Septal Defect and Total AnomalousPulmonary Venous Connection

观察１１２例房间隔缺损（ＡＳＤ）和３９例全肺静脉异位引流（ＴＡＰＶＣ）的ＥＣＧ，若ＱＲＳ电轴正常、左偏或右偏伴Ｖ１呈ｒＳ，可排除ＴＡＰＶＣ。电轴右偏，Ｒｖ１≥１５ｍｍ，Ｖ１呈单纯Ｒ或ｑＲ型，而Ｖ５～６导联为ｒＳ型伴ＰⅡ≥０．２５ｍＶ高度提示ＴＡＰＶＣ。ＴＡＰＶＣ的心导管检查诊断依据：１．ＳａＱ２８０～９０％，且与肺动脉血氧饱和度相近，２．轻度肺动脉高压（≥４．１ｋＰａ）伴大的左向右分流（Ｑｐ／Ｑｓ＞３∶１），３．导管进入异常途径并采血化验血氧含量高于正常，４．肺动脉选择造影右房提早显影。

Electrocardiographic features in 112 cases with atrial septal defect(ASDi and 39 cases with total anomalous pulmonary venous connection (TAPVCj wereobsered. The results showed in case of normal QRS axis, left or right axis deviationwith rS wave in lead V, TAPVC could be eliminated. If it would manifeste the right axisdeviation, RVI 15 mm, alone R or qR wave in V, and rS wave in lead V5-V6 with Pwave 0.25 mv in lead Ⅱ, it would highly indicate the presence of TAPVC. TAPVE fea-tures were diagnostic by cardiac catheterization : 1. Oxygen saturation at 80～90% insystemic arteries as nearly as pulmonary artery. 2. Pulmonary artery pressures arelightly elevated (4. 1kpa) with very large left to right shunts (Qp/Qs 3 : 1). 3. Thecatheter can pass into an anomalous channel in which the blood is highly oxygenated. 4.Selective pulmonary arteriography shows the early development of right atrium.