超声心动图在右肺动脉异常起源于主动脉中的诊断价值
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摘要
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.
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.
引文
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[9]张璟,高燕,马晓静,等.超声心动图对单侧肺动脉起源异常的诊断及随访价值[J].中华医学超声杂志,2016,13(4):276-280.
[10]杨桂荣,王中阳,朱莉,等.超声心动图在重度肺动脉高压房缺封堵术中的应用[J].中华全科医学,2011,9(10):1627-1628
[11]李红玲,郑敏娟,陈文生,等.单侧肺动脉起源异常的超声心动图诊断及外科治疗[J].中国医学影像技术,2011,27(6):1171-1173.
[12]吴开元,李斌,范太兵,等.先天性心脏病漏诊及误诊分析[J].中华实用诊断与治疗杂志,2016,30(2):207-208.
[2]李斌,范太兵,吴开元.主动脉弓中断28例临床分析[J].中华实用诊断与治疗杂志,2014,28(2):173-174.
[3]Xie L,Gao L,Wu Q,et al.Anomalous origin of the right pulmonary artery from the ascending aorta:results of direct implantation surgical repair in 6infants[J].J Cardiothorac Surg,2015,10(1):1-5.
[4]李璐韦,张静,钟家蓉,等.单侧肺动脉起源于升主动脉的超声诊断与预后[J].中国医学影像技术,2015,31(4):550-553.
[5]胡原,陈文娟,李佩岚.儿童右肺动脉异常起源于主动脉的超声心动图特征[J].医学临床研究,2016,33(1):92-93.
[6]张敏郁,牛海燕,高宇,等.经胸超声心动图诊断先天性肺动脉异常起源[J].中华医学超声杂志,2015,12(10):782-785.
[7]刘承虎,李玲,苏俊武,等.手术矫治右肺动脉起源于升主动脉的临床分析[J].心肺血管病杂志,2012,31(2):168-171.
[8]Nathan M,Rimmer D,Piercey G,et al.Early repair of hemitruncus:excellent early and late outcomes[J].J Thorac Cardiovasc Surg,2007,133(5):1329-1335.
[9]张璟,高燕,马晓静,等.超声心动图对单侧肺动脉起源异常的诊断及随访价值[J].中华医学超声杂志,2016,13(4):276-280.
[10]杨桂荣,王中阳,朱莉,等.超声心动图在重度肺动脉高压房缺封堵术中的应用[J].中华全科医学,2011,9(10):1627-1628
[11]李红玲,郑敏娟,陈文生,等.单侧肺动脉起源异常的超声心动图诊断及外科治疗[J].中国医学影像技术,2011,27(6):1171-1173.
[12]吴开元,李斌,范太兵,等.先天性心脏病漏诊及误诊分析[J].中华实用诊断与治疗杂志,2016,30(2):207-208.