超声心动图在先天性主动脉缩窄中的诊断及临床应用价值

Clinical diagnosis and application value of echocardiography in two types of congenital coarctation of aorta

目的评价超声心动图在两种类型主动脉缩窄(COA)中的诊断及临床应用价值。方法对50例COA患者行回顾性对比分析,单纯型25例和复合型25例。通过比较临床及超声特征,评价其临床应用价值。结果单纯型多见于成人患者,复合型多见于儿童患者,复合型较单纯型更易出现紫绀、心力衰竭等临床症状,而单纯型多合并高血压、上下肢血压压差明显等症状,二者差异有统计学意义(P<0.05)。超声影像特征上,两种类型的缩窄范围差异无统计学意义(P>0.05),复合型较单纯型主动脉缩窄多位于动脉导管前,一般狭窄程度较重,易合并其他心内畸形,此外,左心室壁增厚、股动脉频谱流速减低及心功能减低发生率均高于单纯型(P<0.05)。结论比较并明确两种不同类型先天性主动脉缩窄的临床及超声特征差异,有助于COA的早期发现、及时准确术前评估和合适治疗方式的选择。

Objective To evaluate the significance of echocardiography in the diagnosis and clinical application of two types of congenital coarctation of aorta（ COA）. Methods The data of 50 patients with COA were retrospectively analyzed,including 25 patients in simple type group and the other 25 patients in complex type group. The clinical characteristics and ultrasonic features were observed and analyzed,moreover,the clinical application value was evaluated.Results The simple type COA was more observed in adults,however,complex type COA was more observed in children.The complex type COA showed more clinical symptoms including cyanosis and congestive heart failure,as compared with those in simple type COA,however,the latter showed more clinical symptoms including hypertension and obvious blood pressure difference between upper limbs and lower limbs（ P〈0. 05）. The ultrasonographic image showed that there was no significant difference in the coarctation extent between two types of COA（ P〈0. 05）. As compared with simple type COA,in complex type COA the coarctation of aorta was more observed before ductus arteriosus,with more obvious coarctation degree and with being more liable to be complicated by intra- cardiac deformities,in addition,the incidences of left ventricular wall thickening,the decrease of frequency spectrum current velocity of femoral artery and heart function impairment in complex type COA were significantly higher than those in simple type COA（ P〈0. 05）. Conclusion Comparison and identification of the differences of clinical and ultrasonographic characteristics of two different types of congenital COA is helpful for early diagnosis of COA and for timely and accurately preoperative evaluation and selection of appropriate treatment way.