先天性二尖瓣瓣上环的超声心动图诊断价值及漏误诊分析

Missed Diagnosis and Misdiagnosis of Congenital Supravalvular Mitral Ring by Doppler Echocardiography

目的分析先天性二尖瓣瓣上环(CSMR)彩色多普勒超声心动图图像特征,评价超声心动图对CSMR的诊断价值,分析漏、误诊的原因,提高超声心动图技术对CSMR诊断的准确性。资料与方法选择经心外科手术明确为CSMR的66例患儿为研究对象,对其超声心动图检查结果及手术效果进行回顾性分析。结果 66例患儿中,超声诊断符合52例(78.79%);超声漏、误诊14例(21.21%),其中12例术前超声心动图漏诊CSMR,2例术前误诊为三房心。66例患者均合并其他心血管系统畸形,最常见的合并畸形有肺动脉高压、二尖瓣狭窄、室间隔缺损、主动脉缩窄等。53例患者行CSMR切除术,手术前CSMR处最大峰值压差(21.29±10.58)mm Hg,手术后(13.02±5.78)mm Hg,差异有统计学意义(P<0.01)。结论超声心动图技术可以诊断先天性CSMR,但容易漏诊;CSMR外科手术效果良好,但需要注意二尖瓣功能。

Purpose To assess the significance of Doppler echocardiography in the diagnosis of congenital supravalvular mitral ring（CSMR） by exploring the manifestations of Doppler echocardiography, and to analyze the misdiagnosed reasons to improve the correct diagnosis. Materials and Methods Sixty-six children with CSMR confirmed by surgery were recruited in the study. Doppler echocardiography was performed in all the patients and the relationship of imaging findings and surgical findings were retrospectively analyzed. Results Among all 66 cases, 52 cases（78.79%） were correctly diagnosed as CSMR, but 14（21.21%） were missed or misdiagnosed by the echocardiography, among which 12 cases were missed and 2 cases were misdiagnosed as cor triatriatum sinistrum. All of 66 patients were complicated with other cardiovascular malformation, and the most common associated malformations included pulmonary hypertension, mitral stenosis, ventricular septal defects, and coarctation of aorta. The CSMR were resected in 53 children, and the maximum pressure gradient of the CSMR flow decreased from（21.29±10.58） mm Hg to（13.02±5.78） mm Hg, which showed significant difference（P〈0.01）. Conclusion CSMR could be diagnosed by Doppler echocardiography, but it is prone to be missed. The patients with CSMR may have good outcome after surgery, but the doctors need to pay attention to the function of mitral valve.