主动脉弓分析在成人经胸超声心动图检查中的价值

Value of Aortic Arch Analysis During Routine Transthoracic Echocardiography in Adults

目的目前在经胸超声心动图检查中并不常规扫描主动脉弓,这就使得很多发生于主动脉弓的疾病漏诊。该研究的目的是评估在成人经胸超声心动图检查时常规扫描主动脉弓的价值。方法选择856例2010年1月—2010年8月在该院超声心动图室进行经胸超声心动图检查的成年患者（平均年龄52岁,范围18-89）,所有患者均扫描主动脉弓并进行分析。结果经胸骨上切迹切面扫描发现,813例（95%）患者的主动脉弓正常,43例（5%）异常。所有有异常发现的患者中,35例主动脉弓有斑块,其中26例斑块〈4 mm,9例斑块≥4 mm。4例患者有主动脉弓动脉瘤（直径≥4.5 cm）。其他异常包括2例主动脉缩窄,2例A型主动脉夹层动脉瘤。随后,7例接受了手术治疗,4例口服抗凝,28例进行抗血小板治疗和改善危险因素。结论研究发现,在所有进行经胸超声心动图检查的成年患者中有5%的患者主动脉弓有重要的病理学改变,这些患者都接受了相应的干预治疗,这对于改善这些患者的预后具有重要的意义。因此,建议结果所有进行经胸超声心动图检查的成年患者均应进行主动脉弓的扫描。

Objective The majority of clinicians and sonographers do not perform aortic arch analysis routinely during transtho-racic echocardiography （TTE）. The aim of our study is to evaluate the usefulness of aortic arch analysis during routine TTE in adults. Methods We performed aortic arch analysis on all 856adult patients（mean age 52, range 18-89） referred to our echocardio-graphy lab for transthoracic echocardiograms between January and August 2010. Results Suprasternal notch views and aortic arch analysis were normal in 813 patients （95%） and abnormal in 43patients （5%）. Among patients with abnormal findings, 35patients had aortic arch plaques, 26 of themhad plaques 〈4 mm, and 9 patientshad plaques ≥4 mm. Four patients had aortic arch a-neurysms （diameter ≥4.5 cm）. Other abnormal findings included two case of severe stenosis of the inominate artery, and two case of type A aortic dissection. Subsequently, 7 patients underwent surgery, 4 patients were started on oral anticoagulation therapy, and 28 patients treated with an antiplatelet and risk factors modification. Conclusion Aortic arch analysis showed significant pathology in 5% of the adult population undergoing routine TTE. This led to therapeutic interventions in all patients with abnormal findings. Aortic arch analysis should be mandatory during a routine exam and part of any standard digital acquisition protocol for TTE in adults.