超声心动图分析肺静脉异位引流患者引流路径变异与引流静脉狭窄

Echocardiographic analysis on draining path variation and draining vein stenosis with anomalous pulmonary venous connection

目的 通过分析肺静脉异位引流(APVC)患者的超声心动图,总结引流路径变异及引流静脉狭窄特征。方法 回顾性分析2007年4月至2021年11月于解放军总医院第七医学中心经肺静脉CT或手术证实为肺静脉异位引流的221例患儿超声心动图结果,根据发病患儿月龄,分为A组(月龄≤1月)、B组(1月<月龄<6月),C组(月龄≥6月),分析各组间完全性异位引流(TAPVC)与部分性异位引流(PAPVC)数量分布差异。根据是否伴发引流静脉狭窄,分为狭窄组和无狭窄组,分析两组间引流路径变异分布的差异。结果 221例APVC包括TAPVC患者(190例)和PAPVC患者(31例),TAPVC患儿月龄明显偏小,67.3%患儿月龄≤1月,在各月龄组间分布差异有统计学意义(P<0.01)。221例APVC患者共有8种引流路径,经无名静脉引流者狭窄组与无狭窄组分布比例差异无统计学意义(P=0.15),经肝静脉引流患者狭窄组与无狭窄组间分布比例差异无统计学意义(P=0.19),其余6种引流路径均以无狭窄为主,差异有统计学意义(P<0.01)。结论 完全性肺静脉异位引流患儿多于新生儿期发病,心上型经无名静脉引流和心下型经肝内静脉引流者更易合并引流静脉狭窄。

Objective To sum up the characteristics of draining path variation and draining vein stenosis through analyzing echocardiogram in patients with anomalous pulmonary venous connection(APVC).Methods The patients(n=221)with APVC confirmed by pulmonary venous CT or surgery were chosen from the Seventh Medical Center of Chinese PLA General Hospital from Apr.2007 to Nov.2021,and their results of echocardiogram were retrospectively analyzed.According to child patients’month age,all patients were divided into group A(month age≤1),group B(1<month age<6)and group C(month age≥6).The difference in distribution of total APVC(PAPVC)and partial APVC(PAPVC)were analyzed among 3 groups.According to whether APVC complicated by draining vein stenosis or not,the patients were divided into stenosis group and non-stenosis group.The difference in distribution of draining path variation was analyzed between 2 groups.Results Of 221 cases of APVC,there were 190 cases of TAPVC and 31 cases of PAPVC.TAPVC cases were more younger,and 67.3%of them with month age≤1(P<0.01).There were totally 8 draining paths in 221 cases of APVC.The difference in distribution ratio of innominate vein draining path had no statistical significance between stenosis group and non-stenosis group(P=0.15),the difference in distribution ratio of hepatic venous draining path had no statistical significance between stenosis group and non-stenosis group(P=0.19),and other 6 draining paths mostly had no stenosis(P<0.01).Conclusion TAPVC was more common in neonates,and the patients with supracardiac TAPVC via innominate vein and those with infracardiac TAPVC via intrahepatic vein were easily complicated by draining vein stenosis.