超声心动图对婴幼儿先天性冠状动脉瘘的应用价值

Application value of echocardiography for congenital coronary fistula in infants and young children

目的探讨超声心动图对先天性冠状动脉瘘(CAF)的应用价值。方法选择2015年3月至2022年7月在深圳市儿童医院收治的19例先天性CAF患儿,其中男性7例,女性12例;年龄1天~3岁1个月,平均年龄10.56个月;病程0.5~37.3个月,平均病程3.89个月;就诊原因,1例因体检发现,1例因生长缓慢就诊,1例因胸痛就诊,9例因发现心脏杂音而就诊,3例因气促而就诊,2例因胎儿期超声检出CAF而就诊,2例因既往检查发现先天性心脏病(CHD)而就诊。全部患儿行超声心动图检查,观察左右心房室大小、各瓣膜启闭情况和冠状动脉起源、内径及走行、瘘口位置、瘘口大小及术后残余瘘,比较手术前后冠状动脉和心腔的变化。观察手术前后的超声心动图结果,并与手术结果进行对比分析。结果19例先天性CAF患儿手术前后均行超声心动图检查。术前17例患儿超声心动图及手术均发现位置及数目相同的病变,1例术前超声心动图漏诊CAF,1例术前超声心动图显示1个瘘口术中发现2个瘘口。术前超声诊断准确率达89.4%。19例中右CAF 14例(73.7%),左CAF 5例(26.3%)。19例中合并房间隔缺损6例,室间隔缺损3例,法洛四联症1例。冠状动脉不同程度增宽迂曲,内径为2.4~16.0 mm,瘘口直径为1.8~5.0 mm。术后3例超声心动图显示瘘口有残余瘘,8例受累心腔大小恢复正常,8例受累扩张的冠状动脉内径变小。结论超声心动图在先天性CAF的术前诊断、术后随访中具有重要的临床应用价值。

Objective To investigate the application value of echocardiography in congenital coronary fistula(CAF).Methods From March 2015 to July 2022,a total of 19 cases with congenital CAF were enrolled,which included 7 males and 12 females,aged 1 day-3 years and 1 month with mean age of 10.56 months;disease course was 0.5-37.3 months with mean of 3.89 months.The reason for consultation:1 case of physical examination,1 case of slow growth,1 case of chest pain,9 cases of heart murmur,3 cases of shortness of breath,2 cases of CAF detected by fetal ultrasound and 2 cases of congenital heart disease(CHD)detected by previous examination.All of them performed echocardiography to observe the size of left and right atrium,the opening and closing of each valve,the origin,internal diameter and alignment of coronary arteries,the location and size of fistulas and residual fistulas in postoperative period.The changes of coronary artery and cardiac cavity before and after operation were compared,the results of echocardiography before and after operation were observed and compared with the results of operation.Results Echocardiography was performed in 19 cases of CAF before and after operation.The same location and number of lesions were found in 17 cases of preoperative echocardiography and operation,CAF was missed in 1 case of preoperative echocardiography,and 2 fistulas were found in 1 case of preoperative echocardiography.The accuracy of preoperative ultrasound diagnosis was 89.4%.There were right CAF in 14 cases(73.7%)and left CAF in 5 cases(26.3%).Among the 19 cases,there were 6 cases with atrial septal defect,3 cases with ventricular septal defect and 1 case with tetralogy of Fallot.The coronary arteries were widened and tortuous in different degrees,with inner diameter of 2.4-16.0 mm and fistulae diameter of 1.8-5.0 mm.The postoperative echocardiography results showed residual fistula in 3 cases,the size of affected heart chamber returned to normal in 8 cases,and diameter of affected dilated coronary artery became smaller in 8 cases.Conclusion It is demonstrated that echocardiography showes important application value in preoperative diagnosis and postoperative efficacy evaluation of CAF.