25例肺静脉异位引流的超声心动图分析

Echocardiographic manifestations of anomalous pulmonary venous drainage in 25 cases

目的探讨肺静脉异位引流（APVD）的超声表现，以及经胸及经食道超声心动图在诊断APVD中的应用价值。方法回顾性分析资料，2000年6月至2005年6月共有25例经TEE或经手术证实的APVD患者．男14例，女11例，年龄4～59岁，平均（29．56±10．38）岁。其中，完全型（TAPVD）7例，部分型（PAPVD）18例。结果APVD无特异性的临床特点。所有患者经胸超声心动图均显示右房室增大。78％（14／18）的PAPVD合并房间隔缺损，4例PAPVD不合并其他畸形。7例TAPVD经胸超声心动图（TTE）正确诊断6例（85．71％）。TTE诊断及疑似诊断PAPVD为52．94％（9／17例），单纯TEE的诊断正确率为84．62％（11／13例）。联合TTE及TEE检查，PAPVD的检出率提高到92．31％（12／13）。结论对右房室增大伴或不伴肺动脉高压的患者无论有无房间隔缺损均应警惕合并APVD，特别是部分型APVD的可能，应常规对肺静脉进行检测。联合TTE和TEE检查有助于提高APVD，尤其是部分型APVD的检出。

Purpose To evaluate the value of echocardiography in detection of anomalous pulmonary venous drainage （APVD）. Methods Between June 2000 to June 2005,25 patients [14 male, 11 female,mean age （29.56 ± 10.38） years] with APVD were diagnosed by transesophageal eehocardiography （TEE） or surgery,including 7 total APVDs and 18 partial APVDs. Twenty-two of them underwent operation. Results All patients had dilated right ventricle and right atrium. 14 of the 18 PAPVDs had atrial septal defect （ASD） ,4 of them had no other cardiac deformities. Six of the 7 cases with TAPVD （85.71%） were identified by transthoracic echocardiography （TIE） ,while only 9 cases of PAPVD （52. 94%） were diagnosed or suspected by TTE. With TEE only, 84. 62% of PAPVD cases could be detected. Combining TTE and TEE,92.31% cases with PAPVD could be correctly diagnosed. Conclusions For all patients with dilated right heart,no matter with ASD or not, the 4 pulmonary veins should be routinely explored. Combining TTE with TEE may improve the accuracy of diagnosis for APVD,especially for PAPVD.