主动脉左室隧道彩色多普勒超声心动图图像特征研究

A study on imaging characteristics of color Doppler echocardiography of aortic left ventricular tunnel

目的:探寻主动脉左室隧道(ALVT)彩色多普勒超声心动图(CDE)图像特征。方法:应用CDE检查7例ALVT,寻找ALVT图像特征。7例均经心血管造影对照,5例手术证实。结果:根据CDE图像特征对5例做出正确诊断,1例误诊为左冠状动脉左室瘘,另1例误诊为主动脉瓣狭窄并关闭不全。CDE图像特征明显:①二维超声心动图(2DE)胸骨旁左室长轴切面在主动脉前壁或后壁显示一管状无回声腔与左室流出道相通。彩色多普勒血流显像(CDFI)显示收缩期血流信号从左室流出道进入无回声腔;舒张期血流信号从无回声腔进入左室流出道。②2DE胸骨旁大动脉短轴切面在主动脉窦与主动脉壁之间显示一半月状或新月状无回声腔。CDFI在无回声腔内显示血流信号。③绝大多数病例都合并主动脉瓣发育不全和主动脉瓣关闭不全,半数病例合并二尖瓣关闭不全,个别病例合并室间隔缺损。结论:ALVT的CDE图像特征明显,CDE对ALVT有特异性诊断价值,但需与冠状动脉瘘、主动脉夹层动脉瘤和主动脉瓣关闭不全鉴别。

Objective： To probe the imaging characteristics of aortic left ventricular tunnel （ALVT） in color Doppler echocardiography（CDE）. Methods： Seven patients with ALVT were examined by CDE, to find out the character of ALVT. All of the 7 patients underwent angiocardiography for correlation. Of them, 5 cases were confirmed by operation. Results： Five cases were accurately diagnosed by imaging character of CDE, 1 case was misdiagnosed as the left coronary artery left ventricular fistula, the other one was misdiagnosed as the aortic valve stenosis with insufficiency. The features of CDE image were obvious as follows：①The parasternal long axis view of two-dimensional echocardiography（2DE） image on the front or back wall of aortic valve showed non-echo tubal cavity was connected with left ventricular outflow-tract. CDFI showed that blood flow sign entered into the non-echo cavity from left ventricular outflow-tract during systolic time, and vice versa during diastolic time.②The parasternal short axis view of 2DE image showed semilunar echoless cavity between aortic sinus and aortic wall. CDFI showed blood flow signal in echoless cavity. ③Most patients associated with aortic valve hypoplasia and aortic valve insufficiency, half with mitral insufficiency and very few with ventricular septal defect. Conclusion： The feature of CDE image in ALVT was obvious. CDE was valuable especially in diagnosing ALVT, but it should be differented from coronary artery fistulas, aortic dissecting aneurysm and aortic valve insufficiency.