超声心动图诊断主动脉窦瘤破裂合并室间隔缺损

Echocardiographic diagnosis of rupture of aortic sinus aneurysm complicated with ventricular septal defect

目的:研究主动脉窦瘤破裂与室间隔缺损之间的相互影响,探讨超声心动图诊断主动脉窦瘤破裂合并室间隔缺损的特征及规律性。方法:回顾性观察和分析59例主动脉窦瘤,使用飞利浦IE33、GE Vivid7及GE E9彩色多普勒超声仪成像扫描,观察其二维及彩色多普勒血流成像的特征及规律性,并与心外科手术结果进行对照。结果:59例主动脉窦瘤中,右冠窦瘤51例,无冠窦瘤8例;窦瘤破裂46例;合并室间隔缺损39例(占66%);合并主动脉瓣中度以上关闭不全26例(占44%),其中主动脉瓣脱垂9例(占15%)。本组资料中,主动脉窦瘤的位置、大小、有无破口及破口大小和数量、破入心腔等情况均与术前彩色多普勒超声心动图检查基本符合,术前超声检查明显低估室间隔缺损大小者3例,漏诊室间隔缺损2例(干下型)。结论:超声心动图可明确诊断主动脉窦瘤合并室间隔缺损,但主动脉窦瘤尤其是窦瘤破裂对室间隔缺损的诊断造成一定的干扰,可能导致室间隔缺损被漏诊或低估缺损口大小。二维与彩色多普勒超声成像密切结合,仔细、全面的多切面扫查在很大程度上可减少漏诊和误诊,并可及时发现其合并症,可作为此类患者首选、可靠的检查方法。

Objective： To evaluate the characteristics and regularity of echocardiographic in the diagnosis of rupture of aortic sinus aneurysm （RASA） accompanied with the ventricular septal defect （VSD）, by analyzing the relationship between the RASA and VSD. Methods： The features of two dimension ultrasound and color Doppler flow imaging of 59 patients with ASA were retrospectively analyzed and COulpared with surgical results. Results： In the 59 patients, 51 patients with ASA were orig- inated from right coronary sinus, ruptures were observed in 46 cases; and VSD were observed in 39 cases （66%）; and aortic insufficiency were observed in 26 cases （44%）（in which aortic valve prolapse were observed in 9 cases （15%））. The location, size, rupture, drainage chamber of RASA diagnosed by uhrasonography were all confirmed by the surgical results; the size of VSD was underestimated by uhrasonography in 3 cases, and 2 VSD cases were misdiagnosed（stem inferior type）. Conclusions： Echocardiography can diagnose RASA accompanied with VSD accurately, but VSD could be possibly misdiagnosed or underes- timated ventage size. In order to improve diagnose more accurately and reduce misdiagnose and missed diagnosis, it is very important to observe the echocardiographic characteristics carefully and precisely by combined two dimension ultrasound and color Doppler flow imaging. This method could be as an optimizing in the diagnosis way to diagnose RASA combined with VSD.