主动脉弓降部异常的超声诊断

Diagnosis of three categories of aortic arch abnormalities by echocardiography

目的 提高超声对主动脉弓中断 (IAA)、主动脉缩窄 (CoA)、右位主动脉弓 (RAA )三类主动脉弓降部异常的诊断能力。方法 回顾性分析 5 2例主动脉弓降部异常患者的胸前及胸骨上窝二维及多普勒超声表现。结果 IAA表现为主动脉弓部成为盲端 ,降主动脉与肺动脉相连 ,最常合并室间隔缺损 ,均有重度肺高压等。CoA表现为主动脉峡部狭窄 ,降主动脉常窄后扩张 ,腹主动脉内血流频谱异常等 ,部分无心内畸形 ,可通过胸骨上窝及心内表现不同与IAA加以鉴别。RAA表现为主动脉弓弯向右侧 ,标准切面观察时与IAA相似。大部分合并复杂畸形。结论 超声心动图对于诊断主动脉弓降部异常是一种有效、无创、经济的检查手段。胸骨上窝切面超声表现是诊断本病的关键 。

Objective To improve the diagnosis of three categories of aortic arch abnormalities. Methods Fiftytwo patients with aortic arch abnormalities were selected by twodimensional Doppler analysis from suprasternal and parasternal views using retrospective method. Results Eleven patients were found interrupted aortic arch (IAA), which descending aorta was connected with pulmonary artery through patent ductus arteriosus and usually accompanied with ventricular septal defect or (and) pulmonary hypertension. In 26 patients with coarctation of aorta (CoA), the isthmus of aorta was narrowed with distal part dilatation and the blood flow across the narrow part was accelerated.Some of these cases had no cardiac abnormality. In 15 patients with right aortic arch malposition (RAA), aortic arch abnormalities were similar to IAA when scanned from suprasternal aortic arch long axis view, but the descending aorta could only be shown when the probe was rotated 90 degrees anticlockwise, and RAA usually accompanied with complex congenital heart diseases. Conclusions Echocardiography is useful, harmless and relatively cheap test for aortic arch abnormalities, which suprasternal view is usually helpful to the diagnosis. It should become a necessary view in clinical study in order to avoid misdiagnosis.