心下型完全性肺静脉异位连接的超声诊断价值要点及漏误诊分析
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摘要
目的:探讨超声心动图对心下型完全性肺静脉异位连接(infracardiac total anomalous pulmonary venous connection,ITAPVC)的诊断价值,分析超声心动图漏误诊原因,旨在提高超声对ITAPVC诊断的准确率。方法:回顾性分析53例经手术、多排螺旋CT或心导管造影证实为ITAPVC的临床资料,将术前超声检查的声像图表现与手术、多排螺旋CT或心导管造影结果对比分析,对超声漏、误诊及诊断不明确的声像图进行深入研究与探讨,并总结该病的超声心动图诊断要点。结果:53例病例中,29例在外院初筛,超声心动图正确诊断10例,疑似2例,漏诊15例,误诊2例,2例均误诊为完全性心内型肺静脉异位连接,漏误诊率58.6%;本院超声心动图正确诊断44例,疑似3例,所有正确诊断的病例中均显示左房壁回声完整,4根肺静脉均未与左房连接,可见共同肺静脉干连接垂直静脉,并穿过膈肌同腹主动脉及下腔静脉并行走行进入肝脏,与肝静脉、门静脉或下腔静脉连接。本组检查漏诊5例,误诊1例,漏误诊率11.3%,3例漏诊为房间隔缺损合并重度肺动脉高压,2例因同时合并完全性房室间隔缺损、右房异构而漏诊,1例误诊为完全性心内型肺静脉异位连接。结论:ITAPVC易于漏诊,当出现右房室明显增大、左房室偏小、房水平右向左分流时,应常规探查肺静脉的走行情况。若剑突下扫查发现门静脉、肝静脉或下腔静脉扩张则需高度怀疑ITAPVC,且同时进行心导管或CT血管造影检查,以便早期做出正确诊断,尽早手术,改善患儿的生存率,降低病死率。
引文
[1] Yongxuan P,Yang G,Haibo Z,et al. Positional relationship between the pulmonary venous confluence-vertical vein and atria in infracardiac total anomalous pulmonary venous connection[J]. Pediatr Cardiol,2016,37(2):372-377
[2] Van Son JAM,Hambsch J,Kinzel P,et al. Urgency of operationg in infracardiac total anomalous pulmonary venous connection[J]. Ann Thorac Surg,2000,70:128-130
[3]邹鹏,洪庆山,孙善权,等.超声心动图评估完全型肺静脉异位连接中肺静脉病变[J].中国医学影像技术,2017,33(3):340-344
[4] Amit M,Pranav S,Ramesh P,et al. A rare variety of mixed total anomalous pulmonary venous connection[J].Asian Cardiovasc Thorac Ann,2014,22(7):849-851
[5] Cayre RO,Civetta JD,Roldan AO,et al. Mixed total anomalous pulmonary venous connection:Casereport with bilateral venous collectors[J]. J Am Soc Echocardiogr,2003,16(1):84-87
[6] Ganesan S,Brook MM,Silverman NH,et al. Prenatal findings in total anomalous pulmonary venous return:a diagnostic road map starts with obstetric screening views[J].Ultrasound Med,2014,33(7):1193-1207
[7]郑景浩,徐志伟,刘锦纷,等.新生儿梗阻型完全性肺静脉异位引流的治疗[J].中华胸心血管外科杂志,2011,27(12):709-712
[8] Khanna S,Choudhury M,Kiran U. Total anomalous pulmonary venous connection:post operative problems and management[J]. Indian J Anaesth,2010,53(1):71-74
[9]王静,曹清,李奋,等.心下型完全性肺静脉异位引流亚急诊手术效果分析[J].临床小儿外科杂志,2016,15(3):225-227
[10]Padalino MA,Cavalli G,De Franceschi M,et al. Surgical outcomes of total anomalous pulmonary venousconnection repair:a 22-year experience[J]. J Card Surg,2014,29(5):678-685
[2] Van Son JAM,Hambsch J,Kinzel P,et al. Urgency of operationg in infracardiac total anomalous pulmonary venous connection[J]. Ann Thorac Surg,2000,70:128-130
[3]邹鹏,洪庆山,孙善权,等.超声心动图评估完全型肺静脉异位连接中肺静脉病变[J].中国医学影像技术,2017,33(3):340-344
[4] Amit M,Pranav S,Ramesh P,et al. A rare variety of mixed total anomalous pulmonary venous connection[J].Asian Cardiovasc Thorac Ann,2014,22(7):849-851
[5] Cayre RO,Civetta JD,Roldan AO,et al. Mixed total anomalous pulmonary venous connection:Casereport with bilateral venous collectors[J]. J Am Soc Echocardiogr,2003,16(1):84-87
[6] Ganesan S,Brook MM,Silverman NH,et al. Prenatal findings in total anomalous pulmonary venous return:a diagnostic road map starts with obstetric screening views[J].Ultrasound Med,2014,33(7):1193-1207
[7]郑景浩,徐志伟,刘锦纷,等.新生儿梗阻型完全性肺静脉异位引流的治疗[J].中华胸心血管外科杂志,2011,27(12):709-712
[8] Khanna S,Choudhury M,Kiran U. Total anomalous pulmonary venous connection:post operative problems and management[J]. Indian J Anaesth,2010,53(1):71-74
[9]王静,曹清,李奋,等.心下型完全性肺静脉异位引流亚急诊手术效果分析[J].临床小儿外科杂志,2016,15(3):225-227
[10]Padalino MA,Cavalli G,De Franceschi M,et al. Surgical outcomes of total anomalous pulmonary venousconnection repair:a 22-year experience[J]. J Card Surg,2014,29(5):678-685