先天性主动脉瓣下隔膜型狭窄的电子束CT诊断

Preliminary assessment and diagnosis of congenital discrete subaortic stenosis by using electron beam CT

目的 探讨电子束CT(EBCT)诊断先天性主动脉瓣下隔膜型狭窄的实用价值。方法对EBCT造影诊断为先天性主动脉瓣下隔膜型狭窄的 4例患者进行回顾性分析研究 ,全部病例均经普通X线、超声心动图检查 ,1例行心血管造影 ,2例经手术及病理证实。EBCT检查采用心电门控单层连续容积扫描和心脏长、短轴面电影扫描。结果 4例先天性主动脉瓣下隔膜型狭窄患者的EBCT图像均清晰显示出主动脉瓣下隔膜状的负性充盈征象。 1例合并镜面右位心、主动脉瓣关闭不全 ,1例合并动脉导管未闭、房间隔缺损和主动脉瓣、二尖瓣病变 ,1例合并有室间隔缺损、右位主动脉弓 (Ⅱ型 ) ,1例合并有主动脉瓣、二尖瓣关闭不全。结论 EBCT对先天性主动脉瓣下隔膜型狭窄及并发的心血管畸形可以获得准确的病理解剖诊断 ,能满足临床诊断和手术治疗的要求 ,在左室流出道局部细节的显示上甚至优于常规的心血管造影。在术后随诊观察方面可取代心血管造影。

Objective To evaluate the clinical efficacy of EBCT in diagnosing the congenital discrete subaortic stenosis. Methods Data of four patients with congenital discrete subaortic stenosis diagnosed by EBCT were retrospectively analyzed and further compared with that of surgery and histopathologic examination. Results Contrast enhanced EBCT scanning clearly demonstrated both a direct non-opacified sign in subvalvular regions in all four patients' left ventricle and associated cardiovascular anomalies. Movie mode scanning showed the movement of aortic valve and 'discrete membrane', and revealed distinct topography of subaortic outflow tracts as well. Conclusion EBCT is highly valuable in the diagnosis of congenital discrete subaortic stenosis and associated anomalies by clearly demonstrating the subaortic outflow tract topography and complicated cardiovascular malformations. EBCT could be a complementary examination to cardioangiography, and could replace the cineangiography in the follow-up after operation.