超声心动图对主动脉左心室通道的诊断价值

Echocardiographic diagnosis of aortico-left ventricular tunnel

目的分析主动脉左心室通道(aorta‐1eft ventricular tunnel,ALVT)的超声心动图特征,探讨超声心动图对ALVT的诊断价值.方法分析阜外医院23例ALVT患者的超声心动图结果,将其与术中、心导管、CT所见对比,探讨其诊断该病的准确性.总结超声心动图诊断该病的要点和鉴别诊断技巧.结果23例患者中1例患儿于拟定手术日前1d因左心衰竭、心脏骤停死亡,术前经CT证实为ALVT;1例患儿经心导管造影检查证实为ALVT,但患儿超声心动图和心脏磁共振提示合并左心室致密化不全,未接受手术治疗;余21例患者(91.3%)行手术治疗并诊断为ALVT.超声心动图正确诊断18例(78.2%),1例误诊为主动脉瓣关闭不全,1例误诊为主动脉夹层,2例误诊为主动脉瓣发育异常合并关闭不全,1例诊断为主动脉瓣二瓣化畸形并反流而漏诊ALVT.依据Hovaguimian分型分为Ⅰ型8例(34.8%),Ⅱ型12例(52.2%),Ⅲ型1例(4.3%),Ⅳ型2例(8.7%).不同分型的患者采取不同的手术方式进行矫治.结论超声心动图能较准确地诊断ALVT,但需与其他主动脉向左心室分流或反流的疾病鉴别.超声心动图提供的分型信息有助于手术方式的选择.

Objective To analyze the echocardiographic features of patients with aortico-left ventricular tunnel (ALVT) and explore the value of echocardiography in the diagnosis of ALVT. Methods Echocardiographic features of 23 patients with ALVT who were admitted to Fuwai Hospital from July 2002 to February 2019 were reviewed and analyzed. The accuracy of echocardiographic diagnosis of ALVT was investigated by comparing the results of echocardiographic diagnosis with intraoperative and cardiac catheterization and CT. The diagnosis methodology was summarized. The reasons for misdiagnosis by echocardiography were analyzed. Results Among the 23 patients with ALVT, 1 case was diagnosed through CT examination prior to the operation and died from the cardiac arrest, 1 case was diagnosed through cardiac catheterization and ventriculography, the remaining 21 patients (91.3%) received the surgical operation and were diagnosed as ALVT. Eighteen patients (78.2%) were accurately diagnosed by echocardiography. One case was misdiagnosed as aortic valve insufficiency, one case was diagnosed as aortic bicuspid valve and regurgitation, two cases misdiagnosed as aortic valve dysplasia and insufficiency, and one case was misdiagnosed as aortic dissection. According to Hovaguimian classification: 8 cases (34.8%) were of type Ⅰ, 12 cases (52.2%) of type Ⅱ, 1 case (4.3%) of type Ⅲ, and 2 cases (8.7%) of type Ⅳ.Different types of patients are treated with different surgical methods. Conclusions ALVT can be accurately diagnosed with echocardiography, but it needs to be differentiated from other aorta to left ventricular shunt or reflux diseases. The establishment of the optimal diagnosis process is helpful to avoid and reduce the missed diagnosis and misdiagnosis to the greatest extent, and provides a reliable basis for the selection of surgical methods.