儿童原发隔异位型肺静脉异位引流的超声心动图诊断

Echocardiographic diagnosis of anomalous pulmonary venous drainage due to malpositionof septum primum in children

目的探讨超声心动图对原发隔异位(malposition of septum primum,MSP)型肺静脉异位引流的诊断价值。方法回顾分析7名MSP儿童的超声心动图征象,并于CTA和胸外科直视手术结果比较。结果6例(85.7%)超声诊断正确,1例误诊为单心房。1例合并部分性肺静脉异位引流,6例合并完全性肺静脉异位引流。超声心动图显示所有肺静脉均开口于解剖左房后壁,因原发隔异位导致肺静脉异常引流入右房。剑突下冠状、剑突下矢状、心尖四腔、胸骨旁短轴切面可清晰显示继发隔上边缘带缺如以及原发隔不同程度左移。结论超声心动图作为一种非创伤性的检查手段,能正确诊断原发隔异位,为该病的进一步诊断与治疗提供更多信息。

Objective To assess the diagnosic value of echocardiography in a rare variant of anomalous pulmonary venous drainage caused by malposition of septum primum(MSP).Methods Compared with computed tomography angiography(CTA)or intraoperative findings,the echocardiographic characteristicsof 7 patientswith situs solitus and MSP were analyzed retrospectively.Results Six cases(85.7%)were diagnosed correctly,1 case was misdiagnosed as single atrium.Partially anomalous(1 case)or totally anomalous(6 cases)pulmonary venous drainage directly to the right atrium was found by echocardiography.The pulmonary veins were connected with the posterior wall of the anatomical left atrium,which became incorporated into the right atrium because of atrial septal displacement.The absent of superior limbic band of septum secundum and different degree of the leftward deviation of septum primum were also revealed by echocardiography clearly in subxiphoid coronal,subxiphoid sagittal,apical 4-chamber and parasternal short-axis views.Conclusion Echocardiography,as a noninvasive method,could reveal MSP accurately.It provides more evidence for the further investigation and treatment.