完全性肺静脉异位引流诊断探讨(附91例报告)

Exploration for Diagnosis of Total Anomalous Pulmonary Venous Connection:A Report of 91 Cases

目的 探讨完全性肺静脉异位引流 (TAPVC)诊断方法。方法 总结 1986年 10月 -2 0 0 2年 2月收治入院的91例TAPVC的临床及辅助检查资料。结果 超声心动图与心导管造影比较诊断符合率 10 0 % ,引流位置准确率为 96.7%( 88/91)。 91例进行心导管造影检查明确了类型。 1例心下型TAPVC行MRI检查 ,清楚地显示了肺静脉回流情况及伴发畸形 ,与心导管造影结果一致。结论 心导管造影对本病是一个重要的检查手段 ,尤其对一些复杂型TAPVC、年龄大、临床症状重的患儿 ,为其外科手术提供了正确的解剖及生理数据。超声心动图能较准确地反映完全性肺静脉异位引流部位及其类型 ,但必须在超声心动图能明确排除有混合性异位引流或复杂畸形时才可直接手术。磁共振 (MRI)新技术应用于临床为本病的诊断提供了新方法并弥补了心导管造影的不足 ,尤其是心下型者。

To explore the diagnostic method of total anomalous pulmonary venous connection (TAPVC).Methods The clinical data and laboratory studies in 91 cases of TAPVC from Oct 1986 to Feb 2002 were analyzed.Results The consistent rate of echocardiography with angiocardiography was 100% (91/91) in diagnosis of TAPVC,96.7% (88/91) in identification of the exact connection site.Angiocardiography in 91 cases showed the types and associated malformations of TAPVC.One case of infradiaphragmatic TAPVC underwent MRI,that clearly showed pulmonary venous connection and associated malformation,consistent with angiocardiography.Conclusion Angiocardiography is an important diagnostic method of TAPVC,especially in the mixed TAPVC,elder children,or in the children with severe symptoms.It provides accurate anatomic and physiological data for surgery.Echocardiography can accurately reflect the site and type of TAPVC.Children with TAPVC can be operated on directly when echocardiography has ruled out mixed or complex TAPVC.As a new technique,MRI supplies a method for diagnosis of TAPVC and compensates the drawbacks of angiocardiography,especially in infradiaphramatic TAPVC.