心室双入口彩色多普勒超声心动图特征及规律性研究

Study on image characteristics and regularity of double-inlet ventricle in color Doppler echocardiography

目的:探寻心室双入口(DIV)彩色多普勒超声心动图(CDE)特征及规律性。方法:应用CDE检查46例DIV,寻找CDE特征和规律性,所有病例均有心血管造影对照并经手术证实。结果:根据CDE特征表现对42例做出正确诊断,诊断准确率91.3%,3例误诊右心室双出口,1例误诊完全性大动脉转位。DIV的CDE特征和规律性明显:①在二维超声心动图(2DE)心尖四腔心切面显示房间隔回声完整,室间隔回声全部失落,收缩期显示两组房室瓣关闭,心内十字交叉消失,呈"T字形"改变,称2DE"T字征";舒张期显示两组房室瓣开向一个共同心室腔。彩色多普勒血流显像(CDFI)于舒张期显示两个心房内血流信号通过两组房室瓣进入一个共同心室腔;②根据2DE心尖四腔心切面共同心室腔表现确定DIV心室的类型,其中A型共同心室心内膜和肌小梁回声细腻(占76.1%),B型共同心室心内膜和肌小梁回声粗糙(占4.3%),C型共同心室心尖部显示球室嵴回声(占19.6%);③在2DE胸骨旁大动脉短轴切面判断大动脉的类型,其中Ⅰ型大动脉位置关系正常(占10.9%),Ⅱ型和Ⅲ型显示两条大动脉呈两个环状回声,通过两个环状回声相互位置关系判定转位的类型,其中Ⅱ型两个环状回声呈右前左后排列(占30.4%);Ⅲ型两个环状回声呈左前右后排列(占58.7%)。通过两环内径比较判定是肺动脉狭窄(PS)还是肺动脉高压(PH),其中PS肺动脉内径明显小于主动脉内径(占95.7%);PH肺动脉内径明显大于主动脉内径(占4.3%);④合并PS患者CDFI于收缩期显示过肺动脉五彩镶嵌射流束血流信号;⑤心室双入口患者男性(占78.3%)明显多于女性。结论:DIV的CDE特征及规律性明显,CDE对DIV有特异性诊断价值。

Objective：To explore the imaging characteristics and regularities of color Doppler echocardiography（CDE） in double-inlet ventricle（DIV）.Methods：CDE was used to examine 46 patients with DIV and the imaging characteristics and regularities were observed.Angiocardiography was performed in all cases.Results：Of the 46 patients,42 were correctly diagnosed according to the CDE characteristics（diagnotic accuracy 91.3%）,3 were misdiagnosed as double-outlet right ventricle and 1 as complete transposition of great arteries.The CDE characteristics and regularities of DIV were obvious：① Apical four-chamber view of two-dimensional echocardiography（2DE） showed intact interatrial septum and echo dropout in the whole interventricular septum.When the two atrioventricular valves closed during systole,the ＂cross＂ was replaced by ＂T＂ in the middle of the heart,namely,＂T＂ sign of 2DE;the two atrioventricular valves opened to a common ventricle during diastole.Color Doppler flow imaging（CDFI） showed flow signals from the two atria entered a common ventricle through the two atrioventricular valves;② Type of the ventricle of DIV could be decided according to the features of the common ventricle on apical four-chamber view of 2DE： endocardium and trabecular muscles of the common ventricle showed delicate echo in type A（76.1%） and coarse echo in type B（4.3%）.For type C（19.6%）,bulboventricular ridge could be seen in the apex of the common ventricle;③ Type of the great arteries could be judged on parasternal short axis view of 2DE.Type Ⅰ showed normal relationship of the two great arteries（10.9%）.Type Ⅱ and Ⅲ showed two circular echo signals of the two great arteries and type of transposition could be identified according to the spatial relationship between the two circles： in type Ⅱ （30.4%）,the two circles were located in anterior right-posterior left direction and in type Ⅲ（58.7%）,the two circles in anterior left-posterior right direction.Comparison of the size of the two circles could help to distinguish between PS and PH： in PS（95.7%）,internal diameter of the pulmonary artery was obviously smaller than that of the aorta;in PH（4.3%）,internal diameter of the pulmonary artery was obviously bigger than that of the aorta;④ CDFI showed colorful jet flow through pulmonary artery during systole in patients with PS;⑤ Males （78.3%） suffered more DIV than females.Conclusion：CDE shows obvious imaging features and regularities for DIV and has specific value for its diagnosis.