超声心动图在右肺动脉异常起源于主动脉中的诊断价值

Value of echocardiography to the diagnosis of anomalous origin of the right pulmonary artery from ascending aorta

目的探讨超声心动图在右肺动脉异常起源于主动脉(anomalous origin of the right pulmonary artery from ascending aorta,AORPA)中的诊断价值。方法回顾性分析经超声心动图诊断的25例AORPA患者临床和超声心动图资料。结果 24例患者超声心动图诊断结果与手术诊断结果相符,1例患者漏诊动脉导管未闭;近端型18例,右肺动脉内径为(13.6±3.4)mm,肺动脉收缩压为(112.3±16.5)mm Hg;远端型7例,右肺动脉内径为(14.1±3.0)mm,肺动脉收缩压为(112.1±20.0)mm Hg;24例行手术治疗,1例放弃手术治疗;25例均合并重度肺动脉高压、右心增大及不同程度三尖瓣关闭不全;合并动脉导管未闭者21例,室间隔缺损者5例,房间隔缺损/卵圆孔未闭者5例,法洛四联症者1例,二尖瓣关闭不全者1例,重度三尖瓣关闭不全者3例;超声心动图表现为主肺动脉分叉结构消失,肺动脉主干仅与左肺动脉延续,右肺动脉起源于主动脉。结论超声心动图在AORPA中诊断率较高,有助于早期临床确诊和尽早手术治疗,可作为诊断AORPA的首选方法。

Objective To analyze the value of echocardiography to the diagnosis of anomalous origin of the right pulmonary artery from ascending aorta(AORPA).Methods The clinical data and echocardiographic findings of 25 patients with AORPA were retrospectively reviewed.Results The echocardiographic result was coincident with the surgical findings in 24 patients,only 1patient was misdiagnosed as patent ductus arteriosus(PDA).Eighteen patients were in proximal type,the diameter of right pulmonary artery was(13.6±3.4)mm,and the systolic pulmonary artery pressure was(112.3±16.5)mm Hg.Seven patients were in distal type,the diameter of right pulmonary artery was(14.1±3.0)mm,and the systolic pulmonary artery pressure was(112.3±16.5)mm Hg.Twenty-four patients underwent surgery,and 1gave up.All these 25 patients were complicated with severe pulmonary hypertension,right heart enlargement and medium to severe tricuspid regurgitation occurred,in which 21 patients were complicated with PDA,5 patients were complicated with ventricular septal defect,5 patients were complicated with atrial septal defect/patent foramen ovale,1patient was complicated with tetralogy of Fallot,1patient was complicated with mitral regurgitation,and 3patients were complicated with severe tricuspid regurgitation.Echocardiography showed disappeared normal main pulmonary artery bifurcation structure,and continuation of the main pulmonary artery with the left pulmonary artery.The right pulmonary artery was originated from the aorta.Conclusion Echocardiography has high diagnostic rate for AORPA,which contributes to early clinical diagnosis and surgical treatment,and can be used as the first choice for the diagnosis of AORPA.