左心声学造影在诊断假性室壁瘤及合并附壁血栓中的应用

Application of left echography in the diagnosis of false ventricular aneurysm and mural thrombus

目的探讨左心声学造影(LVO)在诊断假性室壁瘤及合并附壁血栓中的应用价值。方法回顾性分析2018年1月至2024年3月武汉亚洲心脏病医院经胸超声心动图(TTE)检查疑似假性室壁瘤10例患者的临床资料,均行LVO检查进一步诊断假性室壁瘤及是否合并附壁血栓,以CT血管造影(CTA)或心脏磁共振(CMR)检查为金标准分析LVO对假性室壁瘤的诊断价值。结果10例TTE检查疑似假性室壁瘤中,LVO检出6例左室假性室壁瘤和1例右室假性室壁瘤,CTA证实LVO检出的6例左室假性室壁瘤诊断正确,1例右室假性室壁瘤误诊,CMR诊断为右室憩室,LVO对假性室壁瘤诊断正确率为6/7,血栓检出4例,检出率4/4。交通口/假性室壁瘤瘤体最大横径0.46±0.04。1例行冠状动脉搭桥+假性室壁瘤切除术;1例行冠状动脉介入支架手术;4例行保守药物治疗,随访观察;1例右室小憩室暂无须特殊治疗。结论LVO对比剂能清楚显影假性室壁瘤瘤体、部位,并测量瘤体的交通口、大小,显影附壁血栓,是鉴别假性室壁瘤首选的补充检查方法。憩室与假性室壁瘤影像图像相似,CMR检查右心室室壁运动灵敏度和特异度比LVO高。

Objective To evaluate the value of left echography(LVO)in the diagnosis of false ventricular aneurysm complicated with mural thrombus.Methods The clinical data of 10 patients with suspected pseudoventricular aneurysm examined by thoracic echocardiography(TTE)in Wuhan Asian Heart Hospital from January 2018 to March 2024 were retrospectively analyzed.All patients underwent LVO examination to further diagnose pseudoventricular tumor and whether it was complicated with mural thrombosis.Computed tomography angiography(CTA)or cardiac magnetic resonance(CMR)examination was used as the gold standard to analyze the diagnostic value of LVO in the diagnosis of pseudoventricular tumor.Results Among the 10 suspected pseudoventricular tumors examined by TTE,LVO detected 6 cases of left ventricular pseudoaneurysm and 1 case of right ventricular pseudoaneurysm;CTA confirmed that 6 cases of left ventricular pseudoaneurysm detected by LVO were correctly diagnosed,1 case of right ventricular pseudoaneurysm was misdiagnosed,CMR diagnosed right ventricular diverticula,LVO diagnosis accuracy was 6/7,and 4 cases of thrombi were detected.The detection rate was 4/4.The maximum transverse diameter of the tumor body of the communicating mouth/false ventricular aneurysm was 0.46±0.04.1 patient underwent coronary artery bypass grafting and resection of false ventricular aneurysm.1 patient underwent coronary artery interventional stent surgery;4 routine conservative drug treatment,follow-up observation;One case of right ventricular diverticulum did not require special treatment.Conclusions LVO contrast agent can clearly show the tumor body and location,measure the tumor entrance and size,and show mural thrombus.It is the first choice for the identification of false ventricular tumor.The diverticula was similar to the image of false ventricular aneurysm,and the sensitivity and specificity of right ventricular wall motion were higher in CMR than in LVO.