超声心动图对主肺动脉间隔缺损的诊断价值探讨

Diagnostic value of echocardiography for aortopulmonary septal defect

目的分析主肺动脉间隔缺损(APSD)的超声心动图特征,探讨超声心动图对APSD的诊断价值。方法回顾性分析经心导管及手术结果证实的49例APSD患者的超声心动图资料,总结其特征,包括APSD分型、部位、大小、房室大小、分流情况,以及是否合并其他心脏畸形情况。结果①49例患者中,术前超声准确诊断APSD 45例,漏诊4例,诊断准确率91.8%。②超声心动图诊断Ⅰ型11例(22.4%),Ⅱ型24例(49.0%),Ⅲ型14例(28.6%),其中45例分型与经心导管及手术结果相符。③二维超声心动图表现为主肺动脉间隔连续性中断,缺损范围约5~50 mm。左心系统增大22例(44.9%),右心系统增大4例(8.2%),全心扩大(左心为著)21例(42.9%),右室壁增厚4例(8.2%),主动脉、肺动脉内径均增宽,以肺动脉内径增宽为著。彩色多普勒超声表现为左向右分流12例(26.7%),双向分流25例(55.6%),右向左分流8例(17.7%)。轻度肺动脉高压3例(6.1%),中度肺动脉高压10例(20.4%),重度肺动脉高压36例(73.5%)。结论超声心动图是诊断APSD的有效方法,能在术前对其进行详细评估,有助于临床制定治疗方案,具有较好的应用价值。

Objective To analyze echocardiograpic features of aortopulmonary septal defect(APSD),and to explore its diagnostic value.Methods Echocadiographic data of 49 APSD patients who confirmed by cardiac catheterization and operation were analyzed retrospectively.Image data including the type,location,size,shunt,wether merging other cardiac malformation were analyzed.Results①In 49 APSD patients,45 cases were diagnosed preoperatively by echocardiography,4 cases were missed diagnosis,the diagnostic accuracy was 91.8%.②There were 11 cases of typeⅠ(22.4%),24 cases of typeⅡ(49.0%),14 cases of typeⅢ(28.6%).All the 45 cases of echocardiography were consistent with the pathologic results.③Two-dimensional echocardiography showed interruption of the continuity of the main pulmonary artery septum with a defect range of about 5~50 mm.The left ventricular system was enlarged in 22 cases(44.9%),the right ventricular system was enlarged in 4 cases(8.2%),the whole heart was enlarged in 21 cases(42.9%),the right ventricular wall was thickened in 4 cases(8.2%),the inner diameters of aorta and pulmonary artery were widened,especially the inner diameter of pulmonary artery.Color Doppler ultrasound showed left-to-right shunt in 12 cases(26.7%),bidirectional shunt in 25 cases(55.6%),right-to-left shunt in 8 cases(17.7%).Mild pulmonary hypertension was found in 3 cases(6.1%),moderate pulmonary hypertension in 10 cases(20.4%),and severe pulmonary hypertension in 36 cases(73.5%).Conclusion Echocardiography is an effective method for diagnosis of APSD.The preoperative detailed evaluation of APSD is helpful for clinical treatment strategy.