心室憩室的超声心动图特征分析

Analysis of the echocardiographic characteristics of ventricular diverticula

目的回顾性对比分析胎儿、儿童与成人心室憩室的超声心动图特征，探讨憩室的诊断和预后评价要点。方法总结和对比分析8例胎儿、3例儿童以及14例成人心室憩室的超声心动图特征，回顾其临床资料和术中所见等，并对胎儿心室憩室进行追踪随访。结果胎儿心室憩室和儿童心室憩室均为单发。成人14例患者中有3例为多发憩室。单发的成人心室憩室与胎儿组比较，憩室与相应心室面积之比（P=0．021）、相应心室缩短分数（P=0．003）差异有统计学意义。7例合并心律失常和心电图改变的憩室均为纤维型。2例多发憩室伴有左心功能不全。胎儿心室憩室随访，2例出生，3例引产，3例失访。3例儿童心室憩室和2例成人心室憩室进行了手术治疗，效果良好。结论超声心动图作为一种非创伤性技术，能够发现不同年龄段、尤其是胎儿的不同类型心室憩室的特征表现及其他伴发心脏异常，为预后咨询提供依据。

Objective To retrospectively analyzed the eehocardiographic characteristics of ventricular diverticula in fetuses, children and adults, and discuss the main points of diagnoses and prognoses of ventrieular diverticula. Methods Eehocardiographic characteristics, clinical data and intraoperative findings of ventrieular diverticula of 8 fetuses, 3 children and 14 adults were summarized. Results The ventrieular diverticula in 8 fetuses and 3 children were all single. Twenty five diverticula were found in the 14 adult patients ; in other words, there were 3 multiple diverticula found in adult group. A statistical difference was found in ratio of diverticula area and corresponding ventricular area （ P = 0.021）, and corresponding ventricular fractional shortening （ P = 0. 003） between fetal and single adult ventricular diverticula. There were 2 cases with ventricular septal defects, 1 with pericardial effusion, 1 with single umbilical artery, and 2 with atrioventrieular valvular regurgitation in fetal cases. Congenital complex cardiac disease and dextroeardia were found in 1 child. There were 1 case with supravalvutar aortic stenosis, 1 with nonobstructive hypertrophic cardiomyopathy, I with left ventricular noncompaction, and 1 with mitral reguigitation in adult group. All the 7 diverticula with ventricular arrhythmias, ST-T changes and abnormal Q wave were fibrous type. And 2 multiple diverticula were accompanied with ventrieular dysfunction. Among the fetal cases, 2 cases were born, 3 cases were terminated pregnancy, and 3 cases were lost to follow up. Three children and 2 adults were underwent cardiac operations for diverticula with good outcomes. No such complications as cardiac rupture, thromboembolism, and sudden death were found. Conclusions Echoeardiography is a useful method to diagnose ventrieular diverticulum, especially for fetuses,and provide the basis for prognosis consultation.