主动脉弓离断早期影像学诊断2例

2 Cases of imaging in early diagnosis of interruption of aortic arch

目的 总结 2例经主动脉造影确诊的主动脉弓离断 (IAA)伴动脉导管未闭和室间隔缺损的临床资料 ,以期提高对本病的早期诊断率 ,减少由于漏诊而产生致命的医疗事故。方法 回顾性分析 2例主动脉弓离断的临床表现、 X线胸片、超声心动图、心血管造影资料及复习相关文献。结果 详细的心脏听诊只能提示先天性心脏病室间隔缺损 (VSD)或 /和动脉管未闭 (PDA)。四肢血压、血氧饱和度的测定和脉搏的检查可提示合并存在本病的可能。胸片诊断容易漏诊或只提示充血性先天性心脏病。彩色多普勒显示心内畸形效果好 ,但显示主动脉弓降部畸形欠佳 ,容易漏诊。螺旋 CT血管成像 (SCTA)能立体显示主动脉弓降部畸形 ,但不能显示心内畸形。电子束 CT (EBCT)优于 SCTA,但尚未普及。 MRI能显示主动脉弓降部畸形。心导管检查 (包括主动脉造影 )可以明确诊断并分型 ,在术前肺血管评价中有重要价值。结论 IAA是一种少见的复杂畸形的先天性心脏病 ,如能提高对本病的认识 ,在临床工作中注意能提示 IAA存在的一些征象 ,辅以适当的实验室检查 。

Objective To conclude 2 cases of IAA accompanied with patent ductas arteriosus and ventricular septal defect,in order to increase the diagnostic rate of IAA and prevent fault of medical treatment.Methods The clinical findings,chest x ray films,cardiac sonography,cardioangiography in 2 cases of IAA were retrospectively analyzed,and also review relavant document.Results Heart ausculation can only point out VSD or PDA.Blood pressures of the four limbs and SpO 2 can point out the possibility of accompanying IAA.Chest x ray Film is easy to omit the diagnosis or can only point out congestive heart diseases.Cardiac sonography is good at revealing intracardiac malformations,but has limitation in demonstrating the abnormalities of descending aortic arch,and also easy to omit the diagnosis.Spiral CT angiography(SCTA)can stereoscopically display the abnormalities of descending aortic arch,but can not reveal intracardiac malformations.Elactron beam CT(EBCT)is superior to SCTA,but is not yet popular.MRI can display the abnormalities of descending aortic arch.Cardiac catheterization(including aortography)can make clear diagnosis and classify the type of IAA,thus has great significance in the evaluation of lung vessels preoperatively.Conclusion IAA is a rare and complex abnormality of congenital heart disease,but it is not difficult in early diagnosis if we pay more attention to the signs and do appropriate accessory examinations.