三种心血管造影组合对肺动脉闭锁肺动脉发育情况的评价分析

Assessment of Pulmonary Arteries in Pulmonary Atresia by Three Kinds of Combined Angiography

目的评价分析三种心血管造影组合显示肺动脉闭锁合并室间隔缺损的肺动脉发育情况。资料与方法回顾性分析22例肺动脉闭锁合并室间隔缺损患者的临床资料,包括X线平片、心电图、超声心动图和心血管造影。重点分析三种造影组合对显示肺动脉发育情况的优缺点。结果(1)右心室造影+楔入肺静脉造影共3例,均显示左右肺动脉融合,一侧肺动脉发育细小。(2)右心室造影+弓降部主动脉和/或升主动脉造影共15例,其中11例主要由未闭动脉导管供血,均见左右肺动脉融合,融合部狭窄3例,一侧或双侧肺动脉发育不良或变细8例,2例可见主肺动脉及盲端;另4例左右不融合。(3)右心室造影+弓降部主动脉或升主动脉造影+体肺侧支血管造影共4例,其中1例由细小动脉导管供血,左右肺动脉融合并发育较好;3例均由小体肺侧支和网状细小血管供血,肺动脉发育细小。结论三种心血管造影组合均能有效显示肺动脉发育情况,主动脉造影能全面了解体肺侧支血管分布,选择性侧支血管造影是术前栓塞所必要的;楔入肺静脉造影可极好地显示纵隔内肺动脉的情况。

Objective To evaluate the development of pulmonary arteries in pulmonary atresia with ventricular septal defect by three kinds of combined angiography. Materials and Methods The clinic data of 22 eases in pulmonary atresia with ventrieular septal defect, included X-ray film, cardiogram, angiography, were analyzed respectively. The advantage and disadvantage of depicting development of pulmonary arteries with three kinds of combined angiography were emphatically analyzed. Results （ 1 ） Angiography of right ventricle and pulmonary vein wedge angiogram in 3 eases, the diagnosis of confluence of left and right pulmonary arteries was 3 cases, the hypoplasia of left or right pulmonary arteries was found. （2）Angiography of right ventricle and aorta angiogrphy in 15 eases, 11 of 15 were supplied by patent duetus arteries, the diagnosis of confluence was 11 cases, the hypoplasia of left or right pulmonary arteries was found in 8 eases,the stenosis of the part of confluence were 3 eases, blindness of main pulmonary artery was in 2 ease, 4 cases without confluence of left and right pulmonary arteries. （3）Angiogrphy of right ventricle and aorta angiogrphy and selective anglography of collateral vessels in 4 eases,one of them was supplied by small patent duetus artery, the diagnosis of confluence was found, 3 eases were supplied by small systemic pulmonary collateral vessels. Conclusion The development of pulmonary arteries in pulmonary atresia with ventrieular septal defect can be demonstrated by 3 kinds of combined angiography, aorta angiography can demonstrate all of the aortopulmonie collateral vessels, selective angiography of collateral vessels is necessary before interventional therapy, pulmonary vein wedge angiogram is very effective to demonstrate the development of pulmonary arteries in mediastinum.