超声心动图在肺动脉闭锁合并室间隔缺损诊断及外科治疗中的应用价值

Value of Echocardiography Examination in the Preoperative Diagnosis and Surgical Treatment of Pulmonary Atresia With Ventricular Septal Defect

目的:探讨超声心动图在肺动脉闭锁合并室间隔缺损诊断及外科治疗中的应用价值。方法:回顾性选取云南省阜外心血管病医院2018年1月至2020年5月期间外科治疗的肺动脉闭锁合并室间隔缺损患者21例,分析其术前超声心动图特点、解剖分型,评估肺动脉发育及体肺侧支动脉情况,并与CT结果相对比。术中经食道超声心动图监测,术后随访超声心动图评估手术效果。结果:超声心动图对肺动脉闭锁的诊断分型、右肺动脉及McGoon比值的测量结果与CT测值差异均无统计学意义(P均>0.05),左肺动脉测值及Nakata指数较CT测值小(P均<0.05)。术中经食道超声心动图示3例室间隔开窗患儿室水平示右向左或双向分流。术后患者左右肺动脉内径及Nakata指数或新建肺动脉指数均较术前增长,差异均有统计学意义(P均<0.05)。结论:超声心动图可以对肺动脉闭锁合并室间隔缺损患儿的肺动脉发育进行初步评估,结合心血管造影检查制定个体化治疗方案,术中及术后可用于随访评价手术疗效,具有重要临床价值。

Objectives:To investigate the value of echocardiography examination in the diagnosis and surgical treatment of pulmonary atresia with ventricular septal defect(PA/VSD).Methods:Clinical data of 21 patients with PA/VSD,who underwent operation in Fuwai Yunnan cardiovascular hospital from January 2018 to May 2020,were analyzed retrospectively.We summarized the classification and characteristics of echocardiography,measured the pulmonary artery,and checked major aortopulmonary collateral arteries(MAPCAs)and other malformations,and compared the echocardiographic results with computed tomography(CT).The patients underwent intraoperative transesophageal echocardiography and were followed up by echocardiography to evaluate the results of surgical treatments.Results:Results derived from echocardiography and CT,including the diagnosis,anatomic classification,measurement of right pulmonary artery and McGoon ratio,were similar(all P>0.05),the value of left pulmonary artery and Nakata index was lower measured by echocardiography than by CT(all P<0.05).The intraoperative transesophageal echocardiography showed a right-to-left shunt or two-way shunt in 3 children with ventricular septal defect underwent fenestration.The left and right pulmonary artery size and total neo-pulmonary arterial index(TNPAI)were significantly higher after operation than preoperative levels(all P<0.05).Conclusions:Echocardiography can be used to preliminarily evaluate the development of pulmonary artery in children with PA/VSD,echocardiography in combination with pulmonary atresia is helpful to develop a personalized treatment strategy,follow-up evaluation of surgical efficacy during and after surgery.