无顶冠状静脉窦的超声心动图诊断方法

Echocardiography in evaluation of unroofed coronary sinus

目的研究二维超声心动图诊断先天性心脏病一无顶冠状静脉窦（UCS）的思路和方法。方法回顾分析16例经外科手术证实并成功矫治的UCS病例的超声心动图检查资料，总结超声诊断UCS的思路和方法。结果16例UCS术前全部由经胸超声确诊，与术中结果对比，超声诊断正确率100％。其中12例为完全型UCS（75％），4例为部分型UCS。12例（75％）合并永存左上腔静脉经UCS人左房。超声诊断要点如下：①在常规扫查冠状窦的切面无法扫查到正常冠状窦；②房水平分流，CS造成左、右心房之间的分流通道，必有房水平分流，且右房侧分流口位于冠状静脉窦口处，至于分流方向取决于合并的其他畸形；③常合并左上腔静脉经UCS人左房；④由房水平分流引起的心腔结构及血流动力学改变。结论通过对UCS的结构及血流动力学特点的分析，可以建立有效准确的超声心动图诊断方法。

Objective To conclude the diagnostic methodology of unroofed coronary sinus（UCS） by two dimensional echocardiography（2DE）. Methods By analyzing the echocardiographic results of 16 UCS patients who were diagnosed by 2DE and confirmed by operation, the diagnostic methodology of UCS by 2DE was summarized. Results Sixteen patients with UCS were involved in this study. Among them, 12 cases were diagnosed as complete UCS,others were partial UCS（PUCS）. Twelve patients were complicated with persistence of left superior vena cava （LSVC） that was connected to left atrium （LA） through UCS. All of preoperative diagnosis conducted by 2DE were finally confirmed to be consistent with the results of operation. With the analysis of acquired echo images, key points of diagnosis were concluded as follow： 1） normal coronary sinus （CS） could not be detected in the routine 2DE views referring CS. PUCS showed partial absence of CS roof,while complete UCS displayed as total absence of CS. 2）Inter-atrial shunt would definitely be found in UCS and the opening to right atrium must be coronary sinus orifice. The shunt direction was depended on the combined cardiac malformations. 3）With the occurrence of UCS, LSVC would be in junction with LA through UCS. 4）The inter-atrial shunt resulted in cardiac morphologic and hemodynamie changes. Conclusions Better understanding of the anatomic,morphological and hemodynamic characteristics of UCS would greatly contribute to accurate diagnosis on UCS.