超声心动图与心导管定性与定量诊断先心病室间隔缺损初探

A PRELIMINARY STUDY OF THE QUALITATIVE AND QUANTITATIVE DIAGNOSIS OF CONGENITAL VENTRICULAR SEPTAL DEFECTS USING ECHOCARDIOGRAM AND CARDIAC CATHETERIZATION

目的：该文旨在探讨超声心动图与心导管检查对先天性心脏病室间隔缺损（VSD）的定性与定量的诊断价值，为临床对VSD的诊断与治疗提供参数与依据。方法：经手术证实的35例VSD，与术前超声心动图、心导管检查结果进行对比研究。结果：该组病例中，二维超声检查22例，与手术对照诊断特异性95．5％（21／22，术中见VSD直径0.5～3.5cm），说明二维超声对直径0．5cm以上VSD的位置和大小的定性与定量诊断是可靠和准确的；心导管检查24例，与手术对照诊断符合率83．3％（20／24）。二维超声与心导管检查对VSD的术前诊断与手术诊断比较有显著意义（P＜0.01）。该组病例术后一年无死亡，与心导管准确提供肺动脉压力密切相关，肺动脉压力与VSD大小之间关系密切，即肺动脉压力高VSD直径大；VSD并重度肺动脉高压患者，当肺动脉压力与周围动脉比值≤0.90时，手术效果好。结论：二维超声心动图与彩色多谱勒一样能对绝大多数VSD作出准确诊断；肺动脉压力与VSD关系密切。

Echocardiography and cardiac catheterization were used to diagnose ventricular spetal defects (VSD) and clinical experience for the diagnosis and therapy of VSD was obtained. open heart surgery was use to confirm 35 cases of VSD. Twenty two patients were preoperatively diagnosed by echocardiography, and 24 patients were diagnosed by cardiac catheterization. When compared with surgical findings, two dimensional echocardiogaphy (2DE) was correct in the diagnosis of 95. 5% (21／22) of the suspected VSD cases, whilecardiac catheterization was successful in diagnosing only 83. 3% (20／24) of the cases. They significantly correlated with surgery in the diagnosis of VSD(P < 0. 01 ). Because of the accurate results of the systolic pulmonary pressure (SPP) provided by cardiac catheterization,no deaths were reported one year post-operatively. The SPP was closely related to the size of the defect. When the SPP was higher, the defect was found to be larger. When the ratio of the SPP and the circular artery pressure was less than 0. 90, the surgical results were better. In conclusion, the results indicate the SDE can replace cardiac catheterization in most VSD patients, even without color dappler.