完全性肺静脉异位引流的超声心动图诊断价值

Value of Echocardiography in diagnosis of total anomalous pulmonary venous connection in Children

自1990年6月至1997年1月7年中,我院彩超室共诊断完全性肺静脉异位引流123例,其中45例行心导管及造影检查并证实。其中男28例,女17例,年龄7天至9岁。超声心动图诊断完全性肺静脉异位引流的敏感性为97.7％,特异性为100％,异位引流部位诊断的准确率为100％,其中心内型18例,心上型23例,心下型1例,其中2例合并右位心、多脾综合征、单心室、完全性房室通道、肺动脉闭锁等复杂畸型;3例为心内、心上混合型。认为只要对完全性肺静脉异位引流保持警惕,结合剑下、心尖、左、右侧胸骨旁、胸骨上五个透声窗的全面扫查,超声心动图能完全准确、可靠地诊断完全性肺静脉异位引流及其类型。心导管造影术对完全性肺静脉异位引流无合并其它复杂畸型时的术前诊断并非是不可欠缺的,但必须在超声心动图能明确排除有混合型完全性肺静脉异位引流时才可直接手术。

Total anomalous pulmonary venous connection (TAPVC) were diagnosed by Echocardiography in 123 children in our Echo Lab during June 1990 to January 1997. Forty-five cases of them were advanced confirmed by Catheterization and Angiocardiography. There were 28 males and 17 females with age ranging from 7 days to 9 years old. The sensitivity of Echocardiography to diagnose TAPVC was 97. 7% and the specialty was 100%. The accuracy of Echocardiography to decide drainage site was 100% including intracardiac type 18. supracardiac type 23, infracardiac type 1. There were three cases with the coexistence of intracardiac type and supracardiac type; and two cases with the multiplicitas of dextrocardia, single ventricle . complete AV septal defect and pulmonary atresia. It is concluded that paying high attention and careful and overall scanning from subcostal, apex, left and right paresternal and suprasternal windows, TAPVC and its drainage site can be exactly and reliably diagnosed by Echocardiography. Although Catheterization and Angiocardiography is useful to diagnose TAPVC with complicated malformation,the mixed type of TAPVC must be excluded by Echocardiography before operation.