超声心动图评价大动脉调转术患者冠状动脉解剖类型

Diagnosis of coronary arterial anatomy of patients with arterial switch operation using echocardiography

目的评估超声心动图诊断大动脉调转术（ASO）患者冠状动脉解剖类型的准确性，总结超声观察冠状动脉位置及走行的方法。方法2007年3月至2008年3月共50例患儿单纯依靠超声心动图检查确诊后行ASO，术前超声均对冠状动脉的解剖类型进行了评估，与术中所见进行对比。其中完全型大动脉转位（TGA）23例，右室双出口大动脉关系反位型（DORV）20例，矫正型大动脉转位（CTGA）2例，左室双出口大动脉关系反位型（DOLV）1例，完全型大动脉转位合并完全型肺静脉异位引流2例（TGA＋TAPVc），完全型大动脉转位合并肺动脉瓣及瓣下狭窄（TGA＋PS）2例。结果50例患者中，冠状动脉发育正常40例，冠状动脉畸形10例。除2例因声窗条件差未能诊断冠状动脉解剖类型外，其余48例均能显示出冠状动脉的起源及走行方向，总可显示率为96．0％。与术中所见对比，48例患者超声诊断总正确率为95．8％。其中，冠状动脉正常者除1例因声窗条件未能显示冠状动脉外，其余均诊断正确。10例冠状动脉畸形包括单冠畸形4例；两支冠状动脉起自一个冠状窦2例；左冠状动脉前降支起源于右冠状窦2例；两支冠状动脉起源于相邻两个冠状窦，开口位于冠瓣交界两侧2例。其中1例因声窗限制未能诊断，2例诊断与术中有出入。冠状动脉畸形超声诊断准确率为77．8％。结论通过多切面扫查，超声心动图能够准确诊断绝大部分ASO患者的冠状动脉解剖类型，为ASO提供全面而准确的诊断信息。

Objective To evaluate the accuracy of preoperative diagnosis on the anatomy of coronary artery of patients with arterial switch operation（ASO） using echocardiography, to conclude the diagnostic methods. Methods From March 2007 to March 2008,50 patients were performed ASO after the diagnosis with echocardiography. Prior to the operation, evaluation was conducted to all of anatomical pattern of the coronary artery,and the comparison was made to the observation in the operation. There were 23 patients with complete transposition of great artery （TGA）, 20 patients with double outlet of right ventricle of abnormal great artery （DORV）, 2 patients with corrected transposition of the great arteries （CTGA）, 1 patients with double outlet of left ventricle of abnormal great artery （DOLV）, 2 patients with TGA complicated with total anomalous pulmonary venous connection （TGA ＋ TAPVC）, 2 patients with TGA complicated with pulmonary valve stenosis（TGA ＋ PS）. Results Among 50 patents,there were 40 patients with normal coronary artery, and 10 patients with abnormal coronary arteries. Except for 2 patients failing to being successfully diagnosed due to bad condition of image,48 patients could be revealed the origin and the direction of the major coronary arteries,the visibility proportion was 96.0%. Compared to the observation in the operation,the total echocardiography accuracy for 48 patients was 95.8%. Among the 40 patients with normal coronary arteries,39 patients were diagnosed accurately except 1 patient failed to be showed clearly by echo. In the 10 patients with abnormal coronary arteries, 4 patients with single abnormal coronary artery, 2 patients with 2 coronary artery originating from the same coronary sinus, 2 patients with left anterior descending coronary artery originating from right coronary artery, 2 patients with 2 coronary artery originating from two adjacent coronary sinus. One patient failed to be diagnosed by echo for the bad image,2 patients was misdiagnosed by echo, the accuracy of echo was 77.8%. Conclusions Through multi-section scanning,echocardiography can accurately diagnose anatomical pattern of coronary artery for most of ASO, thus providing comprehensive and accurate diagnosis information for ASO.