右冠状动脉异常起源于肺动脉的超声心动图诊断

Diagnosis of anomalous origin of the right coronary artery from the pulmonary artery by Doppler echocardiography

目的分析右冠状动脉异常起源于肺动脉(anomalous origin of the right coronary artery from the pulmonary arter-y,ARCAPA)的超声心动图图像特征,评价超声心动图对ARCAPA的诊断价值。方法回顾性分析6例经心外科手术证实为ARCAPA患儿的超声心动图资料。结果 ARCAPA声像图特征主要表现为右冠状动脉开口于肺动脉,左冠状动脉增宽、走行迂曲,室间隔内侧枝血流信号。本组单纯性ARCAPA2例,合并房间隔缺损4例。6例患儿中,超声心动图诊断符合4例(占66. 7%);超声心动图漏、误诊2例(占33. 3%),其中1例误诊为左冠状动脉肺动脉瘘,1例房间隔缺损患者,手术时TEE检查发现合并ARCAPA,进行右冠状动脉移植术。结论超声心动图技术可以诊断ARCAPA,但容易漏误诊,需要与冠状动脉肺动脉瘘鉴别。

Objective To review the imaging characteristics and to evaluate the diagnostic value of Doppler echocardiography for anomalous origin of the right coronary artery from the pulmonary artery(ARCAPA).Methods Doppler echocardiography was performed and these images were compared with operative findings in 6 children with ARCAPA.Results ARCAPA was characterized by dilation of left coronary artery,right coronary artery entrance into main pulmonary artery,and collaterals in septum.The associated malformations included atrial septal defect in 4 cases.Four of six cases(66.7%)were diagnosed correctly,the remaining 2 cases(33.3%)were miss-diagnosed,1 case was misdiagnosed as fistula between pulmonary artery and left coronary artery,ARCAPA was found during operation in 1 case with atrial septal defect by transesophageal echocardiography.Conclusion ARCAPA could be diagnosed by Doppler echocardiography.This malformation should be distinguished from coronary artery fistula.