主动脉弓离断的临床X线表现(附7例分析)

Clinical X-ray manifestations of interruption of aortic arch (Analysis of 7 cases)

目的 探讨先天性主动脉弓离断（ＩＡＡ）的临床Ｘ线特点及Ｘ线平片诊断价值。材料和方法 回顾性分析７例（男３例，女４例，年龄３０天～１１岁，平均４岁）经心血管造影（ＡＣＧ）和（或）手术证实的ＩＡＡ患儿的临床、Ｘ线和ＡＣＧ表现及相互关系。结果７例全属Ａ１型，无Ｂ、Ｃ型，均合并心内畸形，术前Ｘ线平片符合诊断３例。主要的Ｘ线征象有：①气管居中（７例）；②主动脉结消失（７例）；③主动脉弓低位征（２例）；④升主动脉发育不良（４例）；⑤右上肺纵隔旁侧支循环血管影（６例）。结论Ｘ线平片诊断ＩＡＡ有局限性，但紧密结合临床可提示诊断，临床＋Ｘ线＋多普勒超声心动图（ＤＥ）的诊断模式可减少误（漏）诊率，确诊靠ＡＣＧ，对有造影禁忌证者，可采用ＭＲ来确诊。

Objective To investigate the clinical X-ray characteristics and the capability of X-ray plain film in the diagnosis of congenital interrupted aortic arch (LAA). Methods The clinical, X-ray and Angiocardiography(ACG) features and their interrelations in 7 IAA cases(3 males and 4 females with ages ranged between 30 days and 11 years and an average of 4 years) were retrospectively analyzed. All cases were confirmed by ACG and/or surgery. Results All of the 7 cases belonged to type A1, without type B or type C. All cases were associated intra-cardiac deformity. X-ray plain film features were:(1)trachea in the middle (7 cases); (2)aortic knob disappeared (7 cases); (3) 'low arch' sign (2 cas-es) ; (4)hypoplastic ascending aorta (4 cases) ; (5) shadows of bypass circulatory blood vessels beside upper right mediastinum (6 cases). Conclusion There are limitations in the X-ray plain film diagnosis of IAA, but it will be helpful for diagnosis in close clinical adoption. The diag-nostic pattern of 'clinical + X-ray + Doppler echocardio-gram(DE)' may decrease the rate of misdiagnosis, Diagnosis may be made with ACG. For patients with contraindication of angiography, MR may be adopted in diagnosis.