经胸超声心动图可减少无顶冠状静脉窦综合征漏误诊率

Transthoracic echocardiography can reduce the misdiagnosis and missed diagnosis of unroofed coronary sinus

目的分析经胸超声心动图诊断无顶冠状静脉窦综合征(UCSS)漏误诊原因,并提出相应的解决策略。方法回顾性分析2015年1月~2024年3月在中国科学技术大学附属第一医院接受手术治疗的12例UCSS患者,男性7例,女性5例,年龄3~74岁。将患者的超声心动图结果进行比较,将纳入患者分为超声确诊组和超声漏误诊组。分析患者术前超声心动图录像资料,记录并分析特异性征象,根据冠状静脉窦显示情况,分为显示清楚、可疑、模糊、未显示/显示不清4种,计算各切面的显示率,分析漏误诊原因,总结无顶冠状动脉窦的超声心动图特征。结果超声确诊组8例,诊断准确率为66.7%,超声漏诊1例,漏诊率为8%,误诊3例,误诊率为25%。在UCSS确诊患者中,显示CS的常用切面的显示率均高于漏误诊组,其中右室流入道非标准切面在所有TTE确诊的患者中均可显示,该切面在两组中差异有统计学意义(P<0.05)。结论超声医师对UCSS解剖、病理生理、血流动力学的理解以及对CS各切面的观察对于准确诊断该病至关重要。经胸超声心动图作为该病极佳的筛查和诊断方式,有助于减少该病的误诊和漏诊率。

Objective To analyze the reasons for missed and misdiagnosis of unroofed coronary sinus syndrome(UCSS)by transthoracic echocardiography and propose corresponding solutions.Methods A retrospective analysis was performed on 12 patients with UCSS who underwent surgical treatment in the First Affiliated Hospital of USTC from 2015 to March 2024,including 7 males and 5 females,aged from 3 to 74 years old.The echocardiographic results of the patients were compared,and the included patients were divided into an ultrasound diagnosis group and an ultrasound missed and misdiagnosis group.The preoperative echocardiographic video data of the patients were analyzed,and the specific signs were recorded and analyzed.According to the display of the coronary sinus,it was divided into four types:clear display,suspicious,blurred,and not clearly visible/not visible.The display rate of each section was calculated,the reasons for missed and misdiagnosis were analyzed,and the echocardiographic characteristics of the UCSS were summarized.Results There were 8 cases in the ultrasound diagnosis group,with a diagnostic accuracy rate of 66.7%,1 case of ultrasound missed diagnosis,with a missed diagnosis rate of 8%,and 3 cases of misdiagnosed,with a misdiagnosis rate of 25%.In patients diagnosed with UCSS,the display rate of commonly used sections showing CS was higher than that in the missed or misdiagnosed group.Among them,the non-standard section of the right ventricular inflow tract could be displayed in all patients diagnosed with TTE,and the difference between the two groups was statistically significant(P<0.05).Conclusion Ultrasound physicians'understanding of anatomy,pathophysiology,and hemodynamics of UCSS,as well as the observation of various sections of CS,are essential for accurate diagnosis of the disease.Transthoracic echocardiography is an excellent screening and even diagnostic method for the disease,and it helps to reduce the misdiagnosis and missed diagnosis rates of the disease.