左冠状动脉起源于肺动脉的超声心动图诊断价值及漏诊分析

The diagnostic value and analysis of misdiagnosis of anomalous origin of the left coronary artery from the pulmonary artery by doppler echocardiography

目的:探讨多普勒超声心动图对左冠状动脉异常起源于肺动脉(ALCAPA)的诊断价值,分析超声心动图漏诊的原因,旨在提高超声对ALCAPA诊断的准确率。方法:本文总结了17例经心血管造影及磁共振检查确诊为ALCAPA的患儿,并与其超声心动图检测结果进行对照。结果:17例患儿中,超声诊断符合11例(占64.7%),超声误诊6例(占35.3%);其中3例超声诊断为扩张型心肌病,2例超声诊断为左冠状动脉肺动脉瘘,1例诊断为二尖瓣中度反流。结论:超声心动图能较准确地诊断ALCAPA,但易漏误诊。左心室明显增大伴室间隔内丰富侧支血流信号者,应高度怀疑AL-CAPA;若左冠状动脉显示不清,应行心血管造影或核磁共振检查。

Objective:To evaluate the diagnostic value of anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA) by doppler echocardiography,to analyze misdiagnosis as well as to improve the echocardiographic diagnosis.Methods:Doppler echocardiography was performed and this imaging was compared with angiocardiographic findings,or with MRI findings in 17 patients.Results:Eleven cases(64.7%) were diagnosed correctly,6 cases(35.3%) were misdiagnosed.In the 6 misdiagnosis cases,3 cases were misdiagnosed as dilated cardiomyopathy,2 cases as coronary pulmonary fistula,1 case as mitral regurgitation.Conclusion:ALCAPA could be diagnosed accurately by doppler echocardiography.We should pay more attention when dialated left ventricle combined with intercoronary collaterals within the ventricular septum.Angiography or MRI should be perfomed in case in which the left coronary artery is not clearly demonstrated by echocardiography.