CTA与经胸超声心动图在法洛四联症及其并发畸形诊断中的应用价值

Value of CTA and transthoracic echocardiography in the diagnosis of tetralogy of Fallot and its concomitant malformations

目的:分析CTA与经胸超声心动图(TTE)在法洛四联症(TOF)及其并发畸形中的应用价值。方法:将35例TOF患儿作为研究对象,以心导管造影及手术结果作为对照,回顾性分析CTA与TTE对TOF及其并发畸形的检出率,以及相关解剖结构测量结果的差异。结果:35例CTA与TTE的检出率均达100.0%。经心导管造影及手术证实并发其他心内外畸形106处;CTA及TTE对心内畸形的检出率分别为81.5%(44/54)、85.2%(46/54),差异无统计学意义(P>0.05);对心外畸形的检出率分别为98.1%(51/52)、61.5%(32/52),差异有统计学意义(P<0.05);总体检出率分别为89.6%(95/106)、73.6%(78/106),差异有统计学意义(P<0.05)。CTA及TTE测得肺动脉主干(MPA)、右肺动脉(RPA)及左肺动脉(LPA)起始部直径与手术结果差异均无统计学意义(均P>0.05);CTA对RPA及LPA远端显示率明显高于TTE,差异均有统计学意义(均P<0.05)。结论:CTA及TTE均可准确诊断TOF,CTA对显示肺动脉远端血管、体-肺侧支及冠状动脉异常等其他并发畸形方面优于TTE,必要时可两者联合应用。

Objective:To analyze the application value of CTA and transthoracic echocardiography(TTE)in tetralogy of Fallot(TOF)and its associated malformations.Methods:35 children with TOF were taken as the research objects,and the results of cardiac catheterization and operation were used as the control.The detection rates of CTA and TTE of TOF and its complications were analyzed retrospectively,as well as the differences in the measurement results of relevant anatomical structures.Results:The detection rates of TOF by CTA and TTE reached 100.0%.106 other cardiac and extracardiac malformations were confirmed by cardiac catheterization and operation.The detection rates on intracardiac malformation by CTA and TTE were 81.5%and 85.2%respectively,there was no statistically significant difference(P>0.05),on extracardiac malformation were 98.1%and 61.5%respectively,the difference was statistically significant(P<0.05),the overall detection rates were 89.6%and 73.6%respectively,the difference was statistically significant(P<0.05).There were no significant differences in the initial diameter of main pulmonary artery(MPA),right pulmonary artery(RPA)and left pulmonary artery(LPA)between CTA,TTE and operation results(all P>0.05).The distal display rate of RPA and LPA by CTA were significantly higher than those by TTE,and the differences were statistically significant(both P<0.05).Conclusions:Both CTA and TTE can accurately diagnose TOF,and CTA is superior to TTE in displaying distal pulmonary artery vessels,somato-pulmonary collateral,coronary artery abnormalities and other concurrent malformations,and can be used in combination when necessary.