超声心动图诊断小儿主动脉弓离断伴迷走右锁骨下动脉的研究

Study of echocardiography in the diagnosis of interrupted aortic arch with aberrant right subclavian artery

目的探讨超声心动图诊断小儿主动脉弓离断伴迷走右锁骨下动脉的可行性及价值。方法选取2012年7月至2016年12月间在浙江大学医学院附属儿童医院就诊的经手术证实的6例IAA伴ARSCA患儿对照手术结果,分析超声心动图特点,并与不伴迷走右锁骨下动脉的主动脉弓离断病例进行比较,分析总结主动脉弓离断伴迷走右锁骨下动脉特有的超声表现。年龄、体重以及肺动脉与主动脉比值等在IAA-B伴ARSCA与IAA-B普通型两组间比较采用t检验。结果 6例主动脉弓离断(均为主动脉弓离断B型)伴迷走右锁骨下动脉,4例误诊为主动脉弓离断C型。主动脉弓离断B型伴迷走右锁骨下动脉特征性表现:主动脉弓离断前发出右、左颈总动脉,与升主动脉一起呈对称的"Y"型,离断后降主动脉发出左、右锁骨下动脉,迷走右锁骨下动脉走行多变。肺动脉直径与主动脉直径的比值增大较未伴迷走右锁骨下动脉者明显。结论超声心动图早期确诊主动脉弓离断同时能检查迷走右锁骨下动脉,提高分型正确率,为外科手术提供全面有效依据。

Objective To explore the value and availability of echocardiography in the diagnosis of interrupted aortic arch(IAA)with aberrant right subclavian artery(ARSCA)in children.Methods The echocardiographic images and clinical data of6patient s with IAA and ARSCA confirmed by operation were analyzed retrospectively.Results six cases of IAA(all were type B)was associated with ARSCA.Among them,4cases were misdiagnosed as IAA-C.In IAA-B associated with ARSCA right and left common carotid artery were originated from the aortic arch before interruption,and they appeared as a symmetrical″Y″shape with ascending aorta;left and right subclavian artery were originated from the aortic arch after interruption,and the blood vessel lines of ARSCA were variable but always extending to the upper right;the ratio of the diameter of pulmonary artery and aorta were increased obviously.Conclusions It is significant to carefully examine aberrant right subclavian artery,and it was help to the cardiac surgery.