单侧肺动脉起源异常的双源螺旋CT造影诊断价值

Imaging value of DSCTA in diagnosis of anomalous origin of one pulmonary artery

目的 评价双源螺旋CT造影（DSCTA）诊断单侧肺动脉起源异常的影像价值.方法 回顾性分析13例经DSCTA诊断单侧肺动脉起源异常患儿临床资料,男7例,女6例;年龄1月龄～18岁,中位年龄1.83岁.复习DSCTA图像特征,并对照超声心动图结果.CTA检查采用前瞻性心电门控扫描.结果 13例均经CTA明确诊断为右肺动脉起源异常,11例起自升主动脉近段,2例起自升主动脉远段.11例合并动脉导管未闭,7例合并主肺动脉间隔缺损、主动脉弓离断（A型）及动脉导管未闭,1例合并主动脉弓部发育不良,1例合并法洛四联症（TOF）,5例合并主动脉右弓右降,1例合并迷走右锁骨下动脉,1例仅为右肺动脉起源于升主动脉.超声心动图诊断肺动脉起源异常8例,3例疑似右肺动脉走行异常,2例漏诊异常起源的右肺动脉.1例合并TOF,10例合并三尖瓣中-重度反流,5例合并主-肺动脉间隔缺损及主动脉弓离断.7例手术,术中所见与DSCTA一致,行肺动脉起源异常矫治及三尖瓣成形术,其中3例术中同时行主动脉弓离断和主-肺动脉间隔缺损并动脉导管未闭修复术;1例术后合并严重肺部感染死亡.结论 DSCTA影像检查在评价肺动脉起源异常疾病中具有显著应用价值.

Objective Evaluating the imaging value of dual source computer tomography angiography （DSCTA） in diagnosis of anomalous origin of one pulmonary artery.Methods Clinical data of 13 patients with anomalous pulmonary artery diagnosed with DSCTA were retrospectively analyzed,and compared with data of echocardiography examination.Results The anomalous pulmonary was clearly diagnosed with DSCTA,which all originated from ascending aorta （AAO）.Thirteen cases presented with anomalous right pulmonary artery.Of the total,11 cases originated from the proximal AAO,and 2 cases originated from the distal AAO.One patient was only with anomalous origin of right pulmonary.11 were complicated with PDA,7 were complicated with aortopulmonary septal defect and interruption of aortic arch（A type）,1 case was complicated with dysplasia of aortic arch,1 case was complicated with aberrant right subclavian arteries,1 case was complicated with tetralogy of fallot（TOF）,and 5 were complicated with right-sided aortic arch and right-sided descending aorta.Eight cases with anomalous pulmonary were diagnosed with echocardiography,3 cases were suspected,and 2 cases were missed.One case was complicated with TOF,5 cases were complicated with aortopulmonary septal defect,interruption of aortic arch （A type） and patent ductus artery （PDA）,and 10 cases were complicated with moderate-severe regurgitation of tricuspid.In the 7 operative patients,there were consistent with DSCTA,the anomalous pulmonary and the complicated deformities were rectified.Conclusion DSCTA owns a high value in diagnosis of anomalous origin of pulmonary artery and complicated abnormities by clearly developing the pathologic anatomic features and cardiovascular malformations.