室间隔缺损修补术后少见并发症的超声心动图诊断病例系列报告

The diagnosis of the rare complications after ventricular septal defect repair surgery by echocardiography

目的探讨室间隔缺损(VSD)修补术后少见并发症的超声心动图诊断要点。方法通过查询北京安贞医院(我院)超声影像报告系统及病案管理系统获取病例信息,纳入2013年1月至2018年4月在我院诊断或随访的VSD修补术后少见并发症的连续病例,术后时间不限,使用Philips IE33彩色多普勒超声诊断仪,选择S5-1探头,频率1~5 MHz。VSD修补术后少见并发症由我院经验丰富的医生确诊,并经团队医生共同确认。结果符合本文纳入标准的VSD修补术后少见并发症34例,男19例,女15例,年龄4个月至25岁,平均(4.7±5.9)岁。28例为术后左室-右房通道(LVRAC)形成,3例为术后主动脉瓣穿孔并主动脉瓣反流,1例为术后LVRAC形成合并主动脉瓣穿孔,2例为术后主动脉-左房通道形成。34例患者中6例接受外科手术矫治,5例LVRAC患者在随诊过程中自行愈合,其余23例患者继续随访观察中。LVRAC超声心动图表现:(1)心尖及剑突下四腔心切面显示三尖瓣隔瓣与二尖瓣前瓣之间回声中断,缺损位于三尖瓣环上方;(2)彩色多普勒显示从左室至右房的异常分流信号;(3)连续多普勒记录到收缩期高速射流频谱。主动脉瓣穿孔超声心动图表现:(1)左心室长轴及大动脉短轴切面显示无冠瓣或右冠瓣局部回声中断;(2)彩色多普勒显示源自瓣叶裂孔处的主动脉瓣反流。主动脉-左房通道超声心动图表现:(1)彩色多普勒显示从主动脉至左房的异常分流信号,左心室长轴、大动脉短轴及五腔心切面均可显示;(2)连续多普勒记录到双期连续性高速射流频谱。结论多切面扫查及密切结合血流频谱特点,可以明确VSD修补术后异常分流信号的诊断。

Objective To investigate the diagnosis key points of the rare complications after ventricular septal defect repair surgery by echocardiography. Methods The echocardiography features of 34 cases with the rare complications diagnosed at Beijing Anzhen hospital after ventricular septal defect repair surgery between January 2013 and April 2018 were retrospectively reviewed.Results In 34 patients,28 patients were diagnosed as left ventricular-right atrial communication,3 patients was diagnosed as aortic valve perforation with regurgitation, 1 patient was diagnosed as left ventricular-right atrial communication and aortic valve perforation,2 patients were diagnosed as aortic-left atrial tunnel. In 34 patients,6 patients underwent correction surgery,5 patients with left ventricular-right atrial communication were healed without surgery and 23 patients were still follow-up. The echocardiography characters of left ventricular-right atrial communication：（ 1） A small defect was showed between tricuspid septal leaflet and mitral anterior leaflet in four-chamber view of apex and subxiphorid. The defect located above tricuspid ring;（ 2） Color Doppler showed abnormal blood flow signal between left ventricle and right atrium;（ 3） Continuous-wave Doppler showed a highvelocity jet during systole. The echocardiography characters of aortic valve perforation：（ 1） A defect was showed on right coronary artery cusp or noncoronary artery cusp in the long axis view of left ventricle and artery short view;（ 2） Color Doppler showed aortic valve regurgitation originating from the defect. The echocardiography characters of aortic-left atrial tunnel：（ 1） Color Doppler showed abnormal blood flow signal between aorta and left atrium in the long axis view of left ventricle,artery short view and fivechamber view;（ 2） Continuous-wave Doppler showed a high-velocity jet during double phase. Conclusion By scanning different views and closely combining the features of the blood flow frequency spectrum,the abnormal blood flow signal can be accurately diagnosed after ventricular septal defect repair surgery.