室间隔膜部膨出瘤超声心动图特征及规律性研究

Study on echocardiographic characteristics of membranous ventricular septum aneurysm

目的探讨室间隔膜部膨出瘤(AMVS)超声心动图特征及规律性。方法应用超声检查77例AMVS患者,所有病例在超声心动图检查之后均经心血管造影证实,并实施室间隔缺损(VSD)封堵术。结果根据超声心动图图像特征对75例作出正确诊断,诊断准确率97.4%。AMVS的超声心动图特征及规律性明显:①二维超声心动图于胸骨旁大动脉短轴观可显示室间隔膜部局限性向右心室膨出,酷似“乳头状”改变,称为二维超声“乳头征”,根据形状差别将AMVS分为三型;②二维超声心动图显示AMVS顶端回声中断的大小与左室造影AMVS顶部VSD直径呈正相关(r=0.77,P<0.05);③绝大多数AMVS均伴有VSD,合并VSD的AMVS有临床意义,否则没有临床意义;④超声心动图诊断AMVS应观察AMVS位置、基底部宽度、高度和顶部回声中断大小以满足临床需要;⑤超声心动图诊断AMVS需与主动脉窦瘤破裂鉴别。结论AMVS的超声心动图特征及规律性明显,超声心动图和彩色多普勒血流显像结合对AMVS具有特异性诊断价值。

Objective To investigate the image characteristics of aneurysm of membranous ventricular septum (AMVS) in echocardiography.Methods Seventy-seven patients with AMVS underwent a simultaneous echocardiographic study and left ventricular angiography before transcatheter closure of ventricular septal defect (VSD).Statistical relationships between the size of the AMVS measured with echocardiography and left ventricular angiography were assessed by simple linear regression analysis.Results Seventy-five patients were accurately diagnosed by echocardiography with two false positive cases.The features of echocardiography image in AMVS were obvious:①The parasternal short axis view of two-dimensional echocardiography (2DE) showed that the ventricular septum bulged locally into right ventricle as papillary,which was named “papillary sign”.②There was a correlation between the size of the AMVS measured by echocardiography correlated and VSD diameter measured by ventricular angiography (r=0.77,P<0.05).③Most AMVS were complicated with VSD.AMVS had no clinical signification unless it combined with VSD.④It was necessary to describe the location,height and the base width of the AMVS,and the discontinuous echo size of the top to meet clinical request.⑤AMVS should be differentially diagnosed with rupture of aortic sinus aneurysm.Conclusions The echocardiography images of AMVS are obvious,which demonstrates echocardiography a promising noninvasive measurement of the AMVS.