先天性冠状动脉畸形的超声心动图诊断

Echocardiographic assessment of congenital anomalies of the coronary arteries

目的探讨超声心动图诊断小儿先天性冠状动脉畸形的意义。方法对本院诊治的30例先天性冠状动脉畸形的超声心动图结果与心血管造影、手术结果进行分析比较。结果冠状动脉异位开口于肺动脉4例,占13%;单支冠状动脉畸形3例,占10%;冠状动脉瘘23例,占77%,累及右冠状动脉12例（52%）,其中多个瘘口1例,左冠状动脉11例（48%）,瘘入右侧心腔11例（48%）,瘘入肺动脉11例（48%）,瘘入左侧心腔1例（4%）。冠状动脉畸形中伴有其他先天性畸形6例（26%）。超声心动图诊断敏感性93%,特异性100%。其中对冠状动脉瘘及瘘口的形态、数目、瘘入的部位准确性达100%,对冠状动脉异位开口于肺动脉及单支冠状动脉畸形各有1例误诊为弹力纤维增生症。结论超声心动图对先天性冠状动脉畸形有较高的诊断价值,可作为首选诊断方法。对心脏扩大、心内膜增厚、心功能弥漫性降低的弹力纤维增生症样超声心动图改变必须保持对冠状动脉畸形的警惕性,应仔细探测左右冠状动脉及分支,并结合心电图等临床资料进行分析。

Objective To assess the accuracy of echocardiographic evaluating congenital anomalies of the coronary arteries in children. Methods Between Dec 2004 and Sep 2006, the echocardiographic results of 30 children with congenital anomalies of the coronary arteries confirmed by operation or/and cardiac catheter examination in our hospital were analyzed. Results The anomalous origin of left coronary artery from the pulmonary （LCAPA） in 4 （13%）, single coronary artery in 3 （ 10 % ）, coronary artery fist ula in 23 （77 % ） with right coronary（52 % ） in 12 （multi-fistula in 1 ） and left coronary artery in 11 （48 % ）. The fistula terminated in the right heart and pulmonary artery was involved 11 cases each（48%） ,only 1 case was terminated in left heart （4%）. The sensitivity of echocardiography in diagnosis was 93% ,and the specificity was 100%. Each of LCAPA and single coronary artery was diagnosis as endocardial fibroelastosis （EFE）. Conclusions Echocardiographic evaluation offers satisfactory congenital coronary anatomy assessment, and can be as the primary method for diagnosis. It should be pay attention to congenital anomalies of the coronary arteries if the image of echocardiography alike EFE,and need to examine the coronary arteries carefully combine the clinical data.