右心声学造影诊断分流性先天性心脏病的应用价值

Right Heart Contrast Echocardiography Diagnosing the Congenital Heart Disease With Shunt

目的:总结右心声学造影在确诊或协助诊断分流性先天性心脏病的应用价值。方法:回顾分析我院2003-03至2009-07常规超声心动图无法确诊而行右心声学造影明确心内有无分流或腔静脉回流是否异常患者276例。根据临床需要和右心声学造影阳性结果分为三组。结果:第一组70例,有临床症状常规超声检查心脏结构正常,右心声学造影检查阳性者34例(48.6%,34/70),阴性者36例(51.4%,36/70)。第二组129例,其中右心声学造影阳性发现并提示肺动脉高压原因者84例(65.1%,84/129),阳性发现与肺动脉高压程度不匹配者34例(26.4%,34/129)。第三组77例,心脏结构异常但肺动脉压不高,右心声学造影阳性者54例(70.1%)。结论:右心声学造影在常规超声检查无法确诊的分流性先天性心脏病、鉴别肺动脉高压原因、了解腔静脉回流路径中具有重要价值,作为常规超声心动图诊断分流性先心病的补充。

Objective： To summarize the value of right heart contrast echocardiography for diagnosing or coordinating diagnosing the patients of congenital heart disease with shunt. Methods： We retrospectively analyzed 276 congenital heart disease patients treated in our hospital from 2003 to 2009.The traditional echocardiography could not clarify if they had the abnormal shunt.The patients,therefore,received right heart contrast echocardiography for clear diagnosis.Evidence of right to left bubble shunt,or abnormal appearance of bubble at chamber（s）was defined as positive finding to approve the related diagnosis.The patients were divided into three groups.Group1,the symptomatic patients with normal heart structure,n=70,Group2,the patients had severe pulmonary hypertension,n=129,and Group3,the patients had abnormal cardiac structure without or with mild pulmonary hypertension,n=77. Results： In Group1,34/70（48.6%）of patients had positive findings by right contrast echocardiography and 36/70（51.4%）with no shunt.In Group2,84/129（65.1%）of patients with positive findings which was related to severe pulmonary hypertension,and 34/129（26.4%）with positive findings which not related to pulmonary hypertension.In Group3,54/77（70.1%）of patients with positive findings. Conclusion：Right heart contrast echocardiography has an important value for diagnosing congenital heart disease with shunt,to find the cause of pulmonary hypertension and the abnormal vena cava return in related patients.