先天性血管环的超声心动图诊断价值分析

Analysis of diagnostic value of congenital vascular ring by Doppler echocardiography

目的探讨先天性血管环(vascular ring,VR)的彩色多普勒超声心动图对VR的诊断价值。方法回顾性分析247例经心外科手术诊断为VR患者的超声心动图检查资料。结果本组双主动脉弓127例、右位主动脉弓伴迷走左锁骨下动脉及左侧动脉导管未闭/韧带88例、肺动脉吊带29例、左位主动脉弓伴迷走右锁骨下动脉及右侧动脉导管未闭/韧带2例、无名动脉压迫1例。本组单纯性血管环68例,合并其他心血管系统畸形179例,常见的合并畸形有室间隔缺损88例、房间隔缺损/卵圆孔未闭64例、左侧上腔静脉残存29例、动脉导管未闭21例、肺动脉瓣狭窄15例、法洛四联症14例、Kommerell憩室12例。247例患者中,超声诊断符合201例(81.38%);漏误诊46例(18.62%),其中41例漏诊,5例误诊。结论多普勒超声心动图技术可以比较准确地诊断VR,但容易漏、误诊,必要时需行心脏CTA检查明确诊断。

Objective To review the imaging characteristics and to evaluate the diagnostic value of echocardiography for congenital vascular ring(VR).Methods Doppler echocardiography was performed and these images were compared with operative findings in 247 children with congenital VR.Results Of the 247 patients,127(51.42%)had double aortic arch(DAA),88(35.63%)had right aortic arch and aberrant left subclavian artery with a left ductus arteriosus or ligamentum(RAA-ALSA-LDA),29(11.74%)had a pulmonary artery sling(PAS),2(0.81%)had left aortic arch and aberrant right subclavian artery with a right ductus arteriosus or ligamentum(LAA-ARSA-RDA),and 1(0.40%)had innominate artery compression.Of the 247 patients,68 had an isolated VR and 179 VR had additional congenital heart disease,the associated malformations included ventricular septal defect(88 cases),atrial septal defect or patent foramen ovale(64 cases),left superior vena cava(29 cases),patent ductus arteriosus(21 cases),pulmonary stenosis(15 cases),Tetralogy of Fallot(14 cases),and Kommerell diverticulum(12 cases).Two hundred and one of 247 cases(81.38%)were diagnosed correctly,and other 46 cases(18.62%)were misdiagnosed.Conclusion VR could be diagnosed accurately by Doppler echocardiography,but it was prone to be misdiagnosed,and CTA could be used to confirmed the diagnosis.