经胸及经食管超声心动图诊断无顶冠状静脉窦综合征

Transthoracic and transesophageal echocardiography in diagnosis of unroofed coronary sinus syndrome

目的:探讨无顶冠状静脉窦综合征(UCSS)的超声心动图特点及诊断价值。方法:回顾性分析经手术证实为UCSS的18例患者的资料。可疑UCSS时结合经食管超声心动图检查,观察经胸超声心动图不同切面(心尖或胸骨旁短轴四腔心切面、右心室流入道切面、剑突下双心房切面)的超声表现,并对其分型。结果:经胸超声心动图明确诊断12例,术前经胸超声心动图结合经食管超声心动图明确诊断17例,超声诊断符合率94.4%(17/18)。18例患者中,Ⅰ型2例,Ⅱ型11例,Ⅲ型5例(术前超声诊断4例,术中经食管超声心动图发现1例)。术前经胸超声心动图3个切面均可显示Ⅰ型患者;心尖或胸骨旁短轴四腔心切面显示Ⅱ型9例,Ⅲ型4例;右心室流入道切面显示Ⅱ型5例,Ⅲ型4例;剑突下双心房切面显示Ⅱ型10例,Ⅲ型4例。结论:经胸超声心动图结合经食管超声心动图检查,有利于术前明确诊断UCSS,减少漏诊、误诊。

Objective： To explore the echocardiographic characteristics and diagnostic value of unroofed coronary sinus syndrome（ UCSS）. Methods： Data of 18 patients with UCSS were analyzed,retrospectively. All the subjects underwent transthoracic echocardiography（ TTE） preoperatively. Transesophageal echocardiography（ TEE） was performed on the patient with TTE suspected UCSS. The echocardiography performances of different views of TTE（ including apical or parasternal short four-chamber view,right ventricular inflow tract view and subcostal view） were observed. And the classification was studied. Results： Totally 12 patients were diagnosed with preoperative TTE,and 17 patients were diagnosed with the combination of preoperative TTE and TEE. the diagnostic accuracy of ultrasound for UCSS was 94. 4%（ 17/18）. In all the 18 patients with UCSS,there were 2 cases of typeⅠ,11 cases of type Ⅱ and 5 cases of type Ⅲ（ 4 cases diagnosed with preoperative TTE,1 case diagnosed with intraoperative TEE）. UCSS of type Ⅰ was detected with TTE for all three views. Apical or parasternal short four-chamber view showed type Ⅱ UCSS in 9 cases,and type Ⅲ UCSS in 4 case. Right ventricular inflow tract view showed type Ⅱ UCSS in 5 cases,type Ⅲ UCSS in 4 cases. Subcostal view showed type Ⅱ UCSS in 10 cases and type Ⅲ UCSS in 4 cases. Conclusion： TTE combined with TEE is helpful for diagnosising UCSS,which can reduce the missed diagnosis and misdiagnosis.