超声诊断冠状动脉左前降支右室瘘1例

Diagnostic value of color Doppler echocardiography for left anterior descending coronary artery fistula to right ventricle: a report of one case

目的探讨彩色超声心动图对先天性冠状动脉瘘的诊断价值及该病的临床表现。方法该院收治的冠状动脉左前降支右室瘘患者1例。方法:采用彩色超声诊断仪对该患者进行诊断,分析该患者的超声心动图表现特征以及临床表现。结果经彩色超声心动图诊断分析,该患者心脏正常位左位心,房室连接一致,大血管与房室连接一致。左位主动脉弓。左右房室腔大小正常。房室间隔连续完整,左冠状动脉增宽,主干内径4.4mm,左前降枝增宽,走行迂曲,最宽处内径:4.0mm。右房室沟处显示囊状回声,大小:13.2×12.1mm,向右心室方向突起,顶端显示一漏口,直径1.6mm。CDFI探及五彩花色血流信号流入右心室腔内,PD为双期血流频谱,Vmax:400cm/s。心动图提示该患者左冠状动脉主干,左前降支囊状扩张,诊断为左冠状动脉左前降支右室漏,经手术证实该诊断无误。结论彩色超声心动图诊断先天性冠状动脉瘘诊断结果准确,对该病具有较高的诊断价值,在临床诊断中可作为对该病进行诊断的首选方法。

Objective To investigate the diagnostic value of color Doppler echocardiography for congenital coronary artery fistula and the clinical manifestations of the disease. Methods Color Doppler echocardiography was used to diagnose a patient with left anterior descending coronary artery fistula to the right ventricle who was admitted to our hospital. The imaging findings and clinical manifestations of the patient were analyzed. Results The color Doppler echocardiography revealed the heart in its normal levocardia position, normal junctions between the atrium and the ventricle and between the major blood vessels and the atrium and ventricle, a left aortic arch, and normal sizes of left/right atrial and ventricular chambers. In addition, the interventricular septum and interatrial septum were continuous and intact; the left coronary artery was widened, and the inner diameter of the left main coronary artery was 4.4 mm; the left anterior descending coronary artery was widened and tortuous, with a maximum inner diameter of 4.0 mm. The right atrioventricular groove showed a cystic echo pattern （13.2×12.1 mm） extruding toward the right ventricle, with a fistula （diameter = 1.6 mm） at the top. The color Doppler flow imaging displayed a colored blood signal into the right atrial chamber. The pulse Doppler showed a double-phase blood flow frequency spectrum （Vmax： 400 cm/s）. The color Doppler echocardiography suggested that the patient had cystic dilatation of the left main coronary artery and left anterior descending coronary artery, leading to a diagnosis of left anterior descending coronary artery fistula to the right ventricle, as confirmed during surgical operation. Conclusion Color Doppler echocardiography is accurate in diagnosing congenital coronary artery fistula and has high diagnostic value for this disease. So it can be used as a primary method for clinically diagnosing this disease.