TTE联合CTA检查对肺静脉异位引流的诊断价值

The diagnostic value of TTE combined with CTA in anomalous pulmonary venous connection

目的探讨经胸超声心动图(TTE)联合CTA检查对肺静脉异位引流(APVC)的诊断价值。方法选取经手术证实的63例APVC患者资料,术前均行TTE检查,61例行CTA检查。以术中诊断标准对TTE及CTA判定的APVC分型、肺静脉异位数量及合并的心血管畸形/病变进行对比分析,评价两种检查方法对APVC诊断的准确性。结果63例中手术证实部分性肺静脉异位引流(PAPVC)48例、完全性肺静脉异位引流(TAPVC)15例。PAPVC分型:心内型25例,心上型19例,心下型1例,混合型3例;TTE对PAPVC分型诊断准确率为64.58%,对存在PAPVC的提示率为75.00%;对肺静脉异位连接支数的诊断准确率为65.79%;对合并心血管畸形/病变诊断准确率为89.83%,漏、误诊6例均为心外血管畸形。CTA检查,分型诊断准确率为97.92%;对肺静脉异位连接支数的诊断准确率为97.37%;对合并心血管畸形/病变诊断准确率为83.05%,漏诊误诊10例以房间隔缺损及瓣膜病变为主。TAPVC分型:心内型8例,心上型4例,心下型2例,混合型1例。TTE对TAPVC分型诊断准确率为73.33%;对合并心血管畸形/病变诊断准确率为83.33%。13例行CTA检查,分型诊断准确率84.62%;对合并心血管畸形/病变诊断准确率为85.71%。结论TTE及CTA检查评价心内外结构畸形各有优缺点,二者联合可实现优势互补,提高对APVC患者术前综合评价的准确性,为外科手术方案制定提供可靠依据。

Objective To evaluate the value of transthoracic echocardiography(TTE)combined with CTA in the diagnosis of anomalous pulmonary venous drainage(APVC).Methods The data of 63 patients with APVC confirmed by operation were analyzed retrospectively.All patients underwent TTE examination and 61 patients underwent CTA examination before operation.The classification of APVC judged by TTE and CTA,the number of anomalies of pulmonary vein and the combined cardiovascular malformations/lesions were compared and analyzed according to the intraoperative diagnostic criteria,and the accuracy of the two methods in the diagnosis of APVC was evaluated.Results Among the 63 cases,PAPVC48 was confirmed by operation and TAPVC15 was confirmed by operation.PAPVC classification included intracardiac type(n=25),supracardiac type(n=19),infracardiac type(n=1)and mixed type(n=3).The diagnostic accuracy of TTE for PAPVC classification was 64.58%,and the hint rate for the presence of PAPVC was 75.00%.The diagnostic accuracy for the number of heterotopic pulmonary vein connections was 65.79%.The diagnostic accuracy for combined cardiovascular malformations/lesions was 89.83%,and 6 cases were missed and misdiagnosed as extracardiac vascular malformations.CTA examination showed that the diagnostic accuracy of typing was 97.92%;the diagnostic accuracy of the number of ectopic connections of pulmonary vein was 97.37%;the diagnostic accuracy of cardiovascular malformations/lesions was 83.05%.10 cases of missed diagnosis were mainly atrial septal defect and valvular disease.TAPVC classification included intracardiac type(n=8),supracardiac type(n=4),infracardiac type(n=2)and mixed type(n=1).The diagnostic accuracy of TTE for TAPVC classification was 73.33%,and for cardiovascular malformations/lesions was 83.33%.13 cases were examined by CTA,the diagnostic accuracy of typing was 84.62%,and the diagnostic accuracy of cardiovascular malformations/lesions was 85.71%.Conclusion TTE and CTA have their own advantages and disadvantages in the evaluation of extracardiac and extracardiac structural malformations,and the combination of them can complement each other's advantages,improve the accuracy of preoperative comprehensive evaluation of APVC patients,and provide a reliable basis for surgical planning.