左旋心及合并畸形彩色多普勒超声心动图特征和规律性研究

A study of the color Doppler ultrasonographic characteristics and regularity in levoversion deformity

目的:探寻左旋心及合并畸形彩色多普勒超声心动图(CDE)特征和规律性。方法:应用CDE检查52例左旋心及合并畸形,寻找左旋心及合并畸形CDE特征和规律性,所有病例均经心血管造影对照,34例经手术证实。结果:根据CDE特征对48例做出正确诊断,诊断准确率92.3%。本组左旋心及合并畸形CDE特征和规律性明显:①左旋心合并8种复杂先天性心脏病,其中矫正性大动脉转位(34.6%)多见,两腔心(19.2%)、心室双入口(15.4%)、右心室双出口(13.5%)和二尖瓣闭锁(11.6%)少见,三尖瓣闭锁、完全性大动脉转位和永存动脉干(各1.9%)罕见。②在每种复杂先天性心脏病中,又合并多种先天性心脏病,其中大动脉转位(98.1%)、肺动脉狭窄(88.5%)、室间隔缺损(60.0%)、房间隔缺损(38.5%)、动脉导管未闭(7.7%)。③合并肺动脉狭窄,彩色多普勒血流显像显示过肺动脉五彩镶嵌射流束血流信号明显;合并室间隔缺损、房间隔缺损和动脉导管未闭彩色多普勒血流显像显示分流束血流信号不明显。④所有左旋心无论合并哪种复杂先天性心脏病,CDE共同特征为心房反位。结论:左旋心及合并畸形CDE特征和规律性明显,应用CDE可对左旋心及合并畸形做出正确诊断,但检查者必须熟练掌握病理解剖,在检查前阅读X线正位胸片对CDE明确诊断有帮助,并可提高检查效率。

Objective： To explore the image characteristics and regularity of color Doppler echocardiography（CDE） on levoversion deformity.Methods： Fifty-two patients with levoversion deformity were examined by CDE to explore their image characteristics and regularity.All cases with levoversion deformity underwent angiocardiography examination after CDE.Thirty-four cases were proved by surgical operations.Results： Forty-eight cases were diagnosed correctly by the features of CDE imaging.The diagnostic accuracy rate was 92.3%.The CDE characteristics of levoversion were： ①Levoversion can be associated with 8 kinds of complicated congenital heart disease,among which corrected transposition of the great arteries（34.6%） were common,bilocular heart（19.2%）,double-inlet ventricle（15.4%）,double outlet right ventricle（13.5%）,and mitral atresia（11.6%） were less common,tricuspid atresia,complete transposition of the great arteries and persistent truncus arteriosus（1.9% each） were rare.②Each kind of complicated congenital heart disease combined multiple congenital heart deformity,among which were transposition of the great arteries（98.1%）,pulmonary stenosis（88.5%）,ventricular septal defect（60.0%）,atrial septal defect（38.5%） and patent ductus arteriosus（7.7%）.③With pulmonary stenosis,color Doppler flow image showed obvious signal of colorful mosaic jet through the pulmonary artery.With ventricular septal defect,atrial septal defect and patent ductus arteriosus,color Doppler flow image showed mild colorful flow signal of shunt.④Despite the diversity of combined congenital heart disease,all cases of levoversion had a common CDE characteristic of atria situs inversus.Conclusions： The image characteristics and regularity of CDE on levoversion deformity were obvious.CDE can be used to correctly diagnose levoversion deformity,only if the operators of CDE have a clear idea of the anatomy of the levoversion.Before examination,reading front view chest X-ray image would be helpful to improve accuracy and efficiency of diagnosis.