儿童迷走锁骨下动脉的超声心动图与CTA术前诊断价值及术后随访分析

Preoperative diagnostic value and postoperative follow-up analysis of echocardiography and CTA in children with aberrant subclavian artery

目的探讨超声心动图与CTA在儿童迷走锁骨下动脉(ASA)的术前诊断及术后随访中的临床价值。方法选取我院经心胸外科手术证实的ASA患儿192例,应用超声心动图与CTA观察心内结构及血管畸形,同时应用CTA观察气管狭窄程度,比较超声心动图与CTA对儿童ASA的术前诊断情况,分析二者在术后6个月评估吻合口血流梗阻及气管狭窄程度的价值。结果192例ASA患儿中,超声心动图准确诊断124例,准确率为64.6%,漏诊67例,误诊1例;CTA准确诊断174例,准确率为90.6%,漏诊2例,误诊16例。192例ASA患儿中,132例合并其他心内结构畸形,超声心动图准确诊断130例,准确率为98.5%,漏诊2例;CTA准确诊断82例,准确率为62.1%,漏诊50例。所有患儿术后均经超声心动图随访,其中81例行ASA移植术及Kommerell憩室切除术的患儿,术后左锁骨下动脉与左颈总动脉吻合口均无明显梗阻(流速<2.0 m/s);2例仅行ASA移植术的患儿,术后左锁骨下动脉与左颈总动脉吻合口流速均稍增快(流速>2.0 m/s);13例仅行Kommerell憩室切除术的患儿,术后2例降主动脉流速均稍增快(流速>2.0 m/s);96例仅处理其他心内结构畸形的患儿,术后5例降主动脉流速均稍增快(流速>2.0 m/s)。CTA术后随访50例,其中14例行ASA移植术及Kommerell憩室切除术的患儿,术后气管均无明显狭窄;2例仅行ASA移植术和4例仅行Kommerell憩室切除术的患儿,术后气管均为轻度狭窄;30例仅处理其他心内结构畸形的患儿,术后气管均为轻度狭窄。结论超声心动图与CTA在术前诊断ASA中各有优势,超声心动图可以更准确地诊断合并其他心内结构畸形,而CTA可以较准确地诊断ASA及气管的狭窄程度;超声心动图与CTA在术后随访过程中可分别用于评估吻合口血流梗阻情况及气管狭窄程度,能综合评估术后恢复效果。

Objective To investigate the clinical value of echocardiography and CTA in the preoperative diagnosis and postoperative follow-up of aberrant subclavian artery(ASA)in children.Methods A total of 192 children with ASA confirmed by cardiothoracic surgery in our hospital were selected,the intracardiac structure and vascular malformation were observe by echocardiography and CTA,and the stenosis degree was observed by CTA.The diagnosis of ASA in children by echocardiography and CTA before operation was compared,and the value of both in evaluating the anastomotic blood flow obstruction and stenosis degree 6 months after operation were analyzed.Results In 192 children with ASA,124 cases were accurately diagnosed by echocardiography,the accuracy was 64.6%,67 cases were missed,and 1 case was misdiagnosed.A total of 174 cases were accurately diagnosed by CAT,the accuracy was 90.6%,2 cases were missed,and 16 cases were misdiagnosed.Of the 192 children with ASA,132 cases were complicated with other cardiovascular malformations.A total of 130 cases were accurately diagnosed by echocardiography,the accuracy was 98.5%,2 cases were missed.A total of 82 cases were accurately diagnosed by CTA,the accuracy was 62.1%,50 cases were missed.All the children were followed up by echocardiography after operation,81 cases with ASA transplantation and Kommerell’s diverticulectomy had no obvious obstruction at the anastomosis of left subclavian artery and left common carotid artery(flow velocity<2.0 m/s).In 2 cases underwent only ASA transplantation,the left subclavian artery and left common carotid artery anastomotic flow velocity increased slightly(flow velocity>2.0 m/s).In13 cases underwent only Kommerell diverticulectomy,2 of them had a slightly faster descending aorta velocity(flow velocity>2.0 m/s).A total of 96 ASA children who were only treated for other intracardiac structural abnormalities,the results showed the velocity of descending aorta increased slightly in 5 patients after operation(velocity>2.0 m/s).There were 50 cases were followed up after CTA,14 cases underwent ASA transplantation and Kommerell’s diverticulectomy,the results showed no obvious tracheal stenosis after operation.2 cases underwent only ASA transplantation and 4 case underwent Kommerell’s diverticulectomy,the results showed mild tracheal stenosis after operation.30 ASA patients who were only treated for other intracardiac structural abnormalities had mild tracheal stenosis after operation.Conclusion Echocardiography and CTA have their own advantages in the preoperative diagnosis of ASA.Echocardiography can more accurately diagnose intracardiac structural malformations,while CTA can more accurately diagnose ASA and tracheal stenosis.Echocardiography and CTA can evaluate anastomotic blood flow obstruction and stenosis degree during postoperative follow-up,and can comprehensively assess the postoperative recovery.