成人矫正型大动脉转位的彩色多普勒超声心动图特征及规律性研究

Study on imaging characteristics and regularity of adult corrected transposition of the great arteries in color Doppler echocardiography

目的:探寻成人矫正型大动脉转位(CTGA)的彩色多普勒超声心动图(CDE)特征及规律性。方法:应用CDE检查40例成人CTGA,35例经心血管造影对照,38例经手术证实。结果:根据CDE特征表现,对39例做出正确诊断,诊断准确率97.5%,1例误诊为完全性大动脉转位。成人CTGA的CDE特征及规律性明显:①二维超声心动图(2DE)心尖四腔心切面所有患者均显示心房与心室连接不一致,其中SLL型显示心房正位、心室左袢;IDD型显示心房反位、心室右袢。②2DE胸骨旁大动脉短轴切面显示两条大动脉呈两个环状回声,称2DE"双环征"。通过两环相互位置关系可确定转位的类型,其中SLL型两个环状回声呈左前右后排列,IDD型两个环状回声呈右前左后排列;根据两个环状回声内径比较可判定是肺动脉狭窄(PS)还是肺动脉高压(PH),其中PS患者显示位于后方的环状回声明显小于位于前方的环状回声,PH患者显示位于后方的环状回声明显大于位于前方的环状回声。③合并房间隔缺损和室间隔缺损患者的彩色多普勒血流显像(CDFI)显示过房间隔和室间隔分流束血流信号不明显;合并房室瓣关闭不全和肺动脉狭窄患者的CDFI显示过房室瓣反流束血流信号和过肺动脉射流束血流信号明显。结论:成人CTGA的CDE特征及规律性明显,应用2DE判断心房与心室连接不一致和心室与大动脉连接不一致是诊断CTGA的关键,CDE对CTGA合并畸形诊断有一定难度,但对外科拟定手术方案有重要临床价值。

Objective： To probe into the imaging characteristics and regularity of color Doppler echocardiography（CDE） with adult corrected transposition of the great arteries （CTGA）. Methods： Forty patients with adult CTGA were examined by CDE, 35 cases had angiocardiography and 38 cases were proved by surgical operations. Result： Thirty-nine cases were properly diagnosed based on the CDE characteristics with diagnostic accuracy of 97.5%, 1 case was misdiagnosed as complete transposition of the great arteries. The CDE characteristic and regularity of adult CTGA were obvious： （1）Apical four-chamber view of two-dimensional echocardiography （2DE） showed atrioventricular discordance in all patients with atrial situs solitus and an L-loop ventricle in SLL and atrial situs inversus and an D-loop ventricle in IDD. （2）The two great arteries appeared as two circular echo signals in the parasternal short-axis view, namely, ＂double circle＂ sign of 2DE. The type of transposition of the great arteries can be concluded according to the relationship between the two circles. In SLL, the two circles were positioned in the left anterior-right posterior direction and in IDD, they were positioned in the right anterior-left posterior direction. Pulmonary artery stenosis（PS） and pulmonary hypertension（PH） could be distinguished according to the internal diameters of the two circles. In PS, the posterior circle was smaller than the anterior one and in PH, the posterior circle was bigger. （3） Color Doppler flow imaging （CDFI） showed unclear shunt flow signals through the interatrial septum or interventricular septum when patients associated with atrial septal defect or ventricular septal defect. In patients associated with atrioventricular valve insufficiency, CDFI showed obvious reflux signals through atrioventricular valve and in those with PS CDFI showed obvious jet flow signals. Conclusions： Aduh CTGA has obvious CDE features and regularities. Identification of atrioventricular and ventriculoarterial discordance with 2DE is the key point to diagnose CTGA. Diagnosis of the associated anomalies of CTGA by 2DE is somewhat difficult but is of great clinical value in deciding operation methods.