心内膜垫缺损造影诊断中漏、误诊造影表现与其手术病理对比研究

Endocardial Cushion Defects: An Analysis of Missed diagnosis and Misdiagnosis and A Comparison of Angiographic with Pathologic Findings

目的 通过对 18例心内膜垫缺损造影诊断与手术病理对比 ,分析其影像病理基础和漏、误诊原因 ,以期客观评价左室造影对心内膜垫缺损的诊断意义和局限性。材料与方法 18例均行左室正位造影 ,其中 6例并行侧位造影。 18例均以心内直视手术修复。将造影诊断与手术结果进行对比。结果 造影诊断部分型心内膜垫缺损 12例 ,完全型心内膜垫缺损 2例 ,左室右房通道2例 ,法鲁四联征 1例 ,三尖瓣下移畸形 1例。手术证实 18例均为心内膜垫缺损 ,其中部分型 11例 ( 1例并法鲁四联征 ) ,完全型 2例 ,单心房腔型 5例。造影诊断与手术结果完全相符 8例 ( 4 4% ) ,造影诊断分型错误 6例 ,漏诊 1例 ,误诊 3例。结论 左室造影是心内膜垫缺损术前重要的检查手段 ,具有特征性的诊断价值 ,但对非典型的造影表现尤其并存心脏及大血管其他畸形的造影表现 ,确诊较为困难 ,宜结合其他影像诊断手段。

Objective To study the pathologic bases of the angiographic findings of endocardial cushion defects (ECD), and to analyze the factors causing missed diagnosis and misdiagnosis by comparing angiographic findings with pathologic results in 18 cases with ECD, and to evaluate left ventriclar angiography in diagnosing ECD.Materials and Methods Left ventriclar angiography in P A position was performed in all 18 patients, with additional lateral angiography in 6 cases. All 18 cases underwent surgery. The angiographic diagnosis was compared with the surgical results.Results Relying on the angiographic findings, the following diagnoses were made: partial ECD (n=12), whole ECD (n=2), left ventricle to right atrium channel (n=2), tetralogy of Fallot (n=1) and Ebstein's anomaly of tricuspid valve (n=1). Surgical results confirmed ECD in all 18 cases, of which 11 cases were of partial type, 2 were of whole type and 5 were of single atrium type. Angiographic diagnosis agreed with the pathologic results in 8 cases (44%). With angiography, typing mistakes occurred in 6 cases, missed diagnosis in 1 and misdiagnosis in 3.Conclusion Left ventricular angiography is an important pre operative examination for revealing ECD. ECD carries some certain characteristic signs on angiography. However, other imaging modalities are needed when no typical angiographic signs can be demonstrated or when other cardiovescular abnormalities are possibly accompanied.