心脏彩超与320排CTA诊断婴幼儿肺动脉闭锁的对比研究

Comparative Study of the Diagnosis of Pulmonary Atresia in Infants by Transthoracic Cardiac Ultrasound and 320-slice Computed Tomography Angiography

目的对比分析经胸超声心动图(transthoracic echocardiography,TTE)和320排动态容积CT血管造影(CT angiography,CTA)在术前对肺动脉闭锁(pulmonary atresia,PA)的诊断价值。方法回顾性分析38例经手术证实为PA患儿的TTE和320排CTA资料,对比分析两者对PA位置、肺动脉血流供应来源、三尖瓣膜启闭情况、右心室大小、房室间隔缺损与否、主动脉与心脏连接位置、心外其他畸形的诊断价值。结果根据手术结果,38例PA患儿中室间隔完整型2例、室间隔缺损型36例;PAⅠ型5例,Ⅱ型12例,Ⅲ~Ⅳ型21例;肺循环由单纯动脉导管供血14例,由体-肺动脉侧支供血17例,由动脉导管和体-肺动脉侧支双重供血7例。TTE和320排CTA对PA及其位置的诊断与手术一致。TTE共漏诊主动脉骑跨2例、右位主动脉弓及降主动脉5例、永存左上腔静脉1例、冠状动脉-右心室瘘1例,4例体-肺动脉侧支供血畸形漏诊。320排CTA漏诊房间隔缺损7例、三尖瓣狭窄合并右心室发育不良2例。TTE、320排CTA对心内畸形诊断的准确率分别为100.0%(69/69)、85.51%(59/69),对心外畸形诊断的准确率分别为91.26%(94/103)、100%(103/103);总的诊断准确率分别为94.77%(163/172)、94.19%(162/172)。TTE和320排CTA诊断心内畸形与心外畸形的准确率差异有统计学意义(P<0.001),但TTE和320排CTA对婴幼儿PA诊断准确率差异无统计学意义(χ^(2)=0.56,P=1.000)。结论320排CTA及TTE均能准确诊断PA,TTE诊断心内畸形的准确率优于320排CTA,但评估大动脉位置关系及体-肺动脉侧支有局限,二者联合应用可减少误诊漏诊的发生。

Objective To compare and analyze the diagnostic value of transthoracic echocardiography(TTE)and 320-slice dynamic volume CT angiography(CTA)to pulmonary atresia(PA)before surgery.Methods The data of 38 infants with surgically confirmed PA diagnosed by TTE and 320-slice CTA were retrospectively analyzed.The diagnostic value of TTE and 320-slice CTA in PA location,pulmonary artery blood supply source,atrioventricular septal defect,tricuspid valve and right ventricle development,location of great artery and its connection with heart,and other extracardiac malformation were compared and analyzed.Results According to the results of operations,2 cases of ventricular septal integrity and 36 cases of ventricular septal defect were found in 38 infants with PA.Among those infants,there were 5 cases of PA type Ⅰ,12 cases of type Ⅱ and 21 cases of type Ⅲ-Ⅳ.Pulmonary circulation was supplied by simple arterial duct in 14 cases,by body-pulmonary artery collateral branch in 17 cases,and by both arterial duct and body-pulmonary artery collateral branch in 7 cases.The diagnosis of PA and its location by TTE and 320-slice CTA was consistent with surgery′s.There were 2 cases of missed aortic straddle,5 cases of right aortic arch and descending aorta,1 case of permanent left superior vena cava,1 case of coronary artery-right ventricular fistula,and 4 cases of patent ductus arteriosus and body-pulmonary artery collateral blood supply were misdiagnosed as patent ductus arteriosus alone by TTE.Then 7 cases of atrial septal defect and 2 cases of tricuspid stenosis complicated with right ventricular dysplasia were missed diagnosed by 320-slice CTA.The accuracy of TTE and 320-slice CTA in the diagnosis of intracardiac malformations were 100.00%(69/69)and 85.51%(59/69)respectively,and the accuracy of extracardiac malformations were 91.26%(94/103)and 100.00%(103/103)respectively;the overall diagnostic accuracy was 94.77%(163/172)and 94.19%(162/172)respectively.The accuracy of TTE and 320-slice CTA in the diagnosis of intracardiac and extracardiac malformations was significantly different(P<0.001),but there was no difference in the overall accuracy of TTE and 320-slice CTA in the diagnosis of infants with PA(χ^(2)=0.56,P=1.000).Conclusion Both 320-slice CTA and TTE can accurately diagnose PA,and the accuracy of TTE in the diagnosis of intracardiac malformation is better than that of 320-slice CTA.However,there are limitations in the evaluation of the relationship between the position of the great arteries and the collateral branches of the body-pulmonary artery,and the combined application of the two can reduce the incidence of misdiagnosis.