十字交叉心畸形超声心动图评价

Echocardiogarphic evaluation of crisscross heart

目的探讨十字交叉心（CCH）畸形的房室连接及房室节段空间位置特征，评价超声心动图的诊断价值。方法依据三节段诊断方法，分析10例CCH的超声心动图声像学特征，并与心血管造影、多排CT或磁共振成像对比。结果10例患者超声心动图均显示左右心室流人道呈交叉关系，阳性率和特异性为100％。室间隔呈水平位9例，矢状位1例。心房正位8例，反位1例，左房对称1例；心室右袢8例，左袢2例。房室连接一致8例，三节段组合{S．D．L}5例，{S．D．D}、{S．D．S}和{S．L．D}各1例；房室连接不一致和不定各1例，三节段为别{I．D．D}和{A．L．L}。房室连接与房室节段空间位置不一致1例，其房室节段组合为{S．L}，而非正常的{S．D}。心室大动脉连接一致1例，不一致9例，其中完全性大动脉转位2例，矫正性大动脉转位1例，右室双出口6例。结论CCH超声心动图特征为左右室流入道呈交叉关系，室间隔呈水平位。剑下长轴或心尖四腔心切面动态系统扫描是诊断的关键。其房室连接及房室节段空间位置非常复杂，有时两者不一致，应分别阐述。

Objective To explore atrioventricular connection and atrioventricular segmental situs in patients with crisscross heart （CCH） and to evaluate the diagnostic value of echocardiography for this anomaly. Methods Ten consecutive patients with crisscross heart were enrolled into this retrospective study. Their eehocardiographic data were analyzed and compared with the results of X-ray angiocardiography and 64-slice multi-detector row computed tomography （MDCT） or MRI. Results The crossing of atrioventricular valves could be seen in each case by scanning in a subxiphoid or apical 4-chamber view. Both the positive rate and the specificity were 100%. Horizontal ventricular septum was in 9 cases and vertical （sagittal） ventricular septum in 1 ease. The segmental set of 8 patients with concordant atrioventricular connection was { S. D. L t in 5 cases, { S. D. D t 1 case, { S. D. S I 1 case and { S. L D } 1 case. The segmental set of 1 case with discordant atrioventricular connection was t I. D. D t and another 1 case with ambiguous atrioventricular connection was { A. L. L }. In 1 case, the atrioventricular connection was inconsistent with the atrioventricular segmental situs. Ventriculoarterial connections were concordant in 1, DORV in 6, TGA in 2 and C-TGA in 1. Conclusion Echocardiography is proven quite helpful in diagnosis of CCH, and continuous sweeps in subxiphoid long-axis plane or apical 4-chamber view play a key role. Both the atrioventricular connection and the atrioventricular segmental situs are complicated so that they are not always concordance with each other. It is necessary to account for separately.