彩色多普勒超声心动图对先天性二尖瓣瓣上环的影像学特点及漏误诊分析

Analysis of missing and misdiagnosis of congenital mitral valve superior ring by color Doppler echocardiography

目的总结先天性二尖瓣瓣上环彩色多普勒超声心动图检查的影像学特点及漏误诊情况,探索超声心动图对先天性二尖瓣病变的价值。方法选取联勤保障部队第910医院收治的经手术已经明确诊断为先天性二尖瓣瓣上环的45例患者。回顾性分析术前患者的彩色多普勒超声心动图结果,查看诊断的结果,并与术后诊断进行对比,分析先天性二尖瓣瓣上环的影像学特点。结果所有患者中超声心动图术前可诊断为先天性二尖瓣瓣上环的患者有32例,瓣上型和瓣内型分别有13例和19例。通过与手术后结果对比,发现有10例漏诊、3例误诊,漏诊率和误诊率分别为22.22%、6.67%。3例误诊患者均诊断为三房心,除此之外,所有患者均合并有其他心血管系统畸形,二尖瓣狭窄、主动脉缩窄等是最常见的畸形。所有患者经手术治疗均能有效的降低二尖瓣瓣上环的最大峰值压差,差异具有统计学意义(P<0.05)。所有手术患者均得到很好的治疗,且术后1年后也未发现再狭窄者。结论先天性二尖瓣瓣上环的诊断首选彩色多普勒超声心动图,简便易操作,且误诊、漏诊的概率较低。

Objective To explore the missing and misdiagnosis of color Doppler echocardiography in congenital mitral valve superior ring to asses the value of echocardiography in congenital mitral valve diseases.Methods A total of 45 patients admitted to 910th Hospital of Joint Logistics Support Force who were surgically diagnosed with congenital mitral valve superior annulus.The preoperative color Doppler echocardiography results of patients were analyzed retrospectively and compared with the postoperative diagnosis to analyze the imaging characteristics of congenital mitral valve superior annulus.Results Among all the patients,32 patients were diagnosed with congenital mitral valve annulus by echocardiography before surgery,with 13 cases of supravalvular and 19 cases of intra valvular,respectively.By comparing with the postoperative results,it was found that there were 10 cases of missed diagnosis and 3 cases of misdiagnosis,with a missed diagnosis rate of 22.22%and a misdiagnosis rate of 6.67%,respectively.All 3 misdiagnosed patients were diagnosed as cor triatriatum.In addition,all the patients were associated with other cardiovascular system abnormalities.Mitral stenosis and coarctation of aorta,etc.were the most common abnormalities.The maximum peak pressure difference of the mitral valve superior annulus was reduced effectively after surgical treatment in all the patients,with a statistically significant difference(P<0.05).No restenosis was found one year after surgery.Conclusion Color Doppler echocardiography is the first choice for the diagnosis of congenital mitral superior annulus.It is simple and easy to operate and the probability of misdiagnosis and missed diagnosis is lower.