肺动脉瓣短轴切面诊断先天性四叶式肺动脉瓣畸形的临床价值

Clinical Value of Short Axial Section of Pulmonary Valve in Diagnosis of Congenital Quadricuspid Pulmonary Valve Malformation

目的探讨经胸超声心动图肺动脉瓣短轴切面的操作手法及其诊断先天性四叶式肺动脉瓣畸形的临床价值。方法患者左侧卧位,必要时平卧位,在胸骨旁左心长轴切面基础上,探头前倾并稍顺时针旋转做到右室流出道长轴切面,显示肺动脉瓣的位置,然后逆时针旋转直至清晰显示肺动脉瓣短轴;或在主动脉根部短轴切面基础上,探头上移前倾直至清晰显示肺动脉瓣短轴。分别对200例正常人和95例肺动脉瓣狭窄或肺动脉瓣轻-中度以上关闭不全患者进行超声心动图检查,做肺动脉瓣短轴切面,重点观察肺动脉瓣叶数目、形态、大小、回声、厚度、附着点、启闭形态。对于主动脉根部短轴切面显示肺动脉瓣增厚、肺动脉瓣狭窄或关闭不全的病例,使用多普勒超声心动图评估肺动脉瓣狭窄或关闭不全的程度。结果200例正常人中,186例肺动脉瓣短轴切面可清晰辨认肺动脉瓣叶数目;95例肺动脉瓣狭窄或肺动脉瓣轻-中度以上关闭不全患者中,93例肺动脉瓣短轴切面可清晰辨认肺动脉瓣叶数目,两者之间比较差异无统计学意义(χ^2=3.008,P=0.083);正常肺动脉瓣为3个半月瓣,分别为左瓣、右瓣和前瓣。在肺动脉瓣短轴切面上,正常三叶式肺动脉瓣舒张期关闭呈“Y”形,收缩期开放呈三角形。95例肺动脉瓣狭窄或肺动脉瓣轻-中度以上关闭不全患者中,发现5例四叶式肺动脉瓣,其中4例伴有不同程度的关闭不全,1例伴有中度狭窄,4例瓣叶为大小对称性,1例瓣叶呈大小非对称性。结论经胸超声心动图可清晰显示肺动脉瓣短轴切面,并可准确诊断四叶式肺动脉瓣畸形,对于明确肺动脉瓣狭窄或关闭不全的病因、选择治疗方案具有重要的临床价值。

Objective To investigate transthoracic echocardiography of the short axial section of pulmonary valve and its clinical value in the diagnosis of congenital quadricuspid pulmonary valve malformation.Methods The patient was in the left lateral position or supine position if necessary.On the basis of parasternal left long axis section,the probe was tilted forward and rotated slightly clockwise to achieve the long axial section of the right ventricular outflow tract,showing the position of the pulmonary valve,and then rotated counterclockwise until the short axis of the pulmonary valve was clearly displayed.Or,on the basis of the short axial section of aortic root,the probe was moved upward and tilted forward until the short axial section of the pulmonary valve was clearly shown.Echocardiography was performed in 200 healthy subjects and 95 patients with pulmonary valve stenosis or greater than mild to moderate insufficiency.The number,shape,size,echo,thickness,attachment point,and opening and closing shape of the pulmonary valve lobes were observed on the short-axis section of the pulmonary valve.Doppler echocardiography was used to assess the extent of pulmonary valve stenosis or insufficiency in the short-axis section of the aortic root.Results The number of pulmonary valve lobes in 186 of 200 healthy subjects could be clearly identified on the short axis of pulmonary valve.Of the 95 patients with pulmonary stenosis or greater than mild to moderate pulmonary insufficiency,the number of pulmonary valve lobes was clearly identified on the short axis of the pulmonary valve in 93 patients,and the difference wasn’t statistically significant(χ^2=3.008,P=0.083).The normal pulmonary valve has three semilunar valve,the left valve,the right valve and the anterior valve.On the short-axis section of the pulmonary valve,the normal three-lobe pulmonary valve closes to be"Y"shape in diastolic and opens to be triangular shape in systolic phase.Of the 95 patients with pulmonary stenosis or greater than mild to moderate pulmonary insufficiency,5 patients with quadricuspid pulmonary valve were found,among which 4 were associated with different degrees of insufficiency,1 with moderate stenosis,4 with symmetric valve size,and 1 with asymmetric valve size.Conculsion Transthoracic echocardiography can clearly show the short-axis section of pulmonary valve,and can accurately diagnose quadricuspid pulmonary valve malformation,which has an important clinical value for determining the cause of pulmonary valve stenosis or insufficiency and choosing the treatment plan.