二维及三维超声心动图诊断肺动脉瓣四叶畸形
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摘要
目的分析先天性肺动脉瓣四叶式畸形(CQPV)的超声心动图表现,探讨其分型情况、瓣膜功能及合并心血管畸形,评价超声心动图诊断CQPV的价值。方法回顾性分析我院经超声心动图诊断为CQPV患者的临床资料和超声心动图影像资料,重点观察CQPV瓣叶的形态、大小、数目、厚度、回声强度、附着点、启闭形态、肺动脉与右心大小以及血流动力学等。结果经超声心动图诊断为CQPV的患者7例,根据Hurwitz和Roberts对四叶瓣的A～G七种分型,A型1例,B型4例,E型2例。7例CQPV均存在狭窄或反流,其中肺动脉瓣狭窄有5例,肺动脉瓣反流有5例,肺动脉瓣反流合并狭窄有3例。7例CQPV有2例合并其他心血管畸形。7例CQPV患者肺动脉瓣跨瓣血流束均为偏心,冲击主肺动脉外侧壁,在主肺动脉内形成漩流,并均有主肺动脉增宽。4例出现右心增大、右室壁增厚等形态学改变。结论二维结合三维超声心动图能够准确显示CQPV患者瓣叶数目、形态及合并畸形,准确评价瓣膜功能与并发肺动脉及右心大小情况,对CQPV的诊断、治疗和预后有重要的临床价值。
Objective To analyze the echocardiographic characteristics of congenital quadricuspid pulmonary valve(CQPV),to explore the leaflet morphology types,valve function and associated cardiac abnormalities,and to evaluate the value of echocardiography in diagnosing CQPV deformity.Methods We retrospectively analyzed the clinical data and echo images of patients with CQPV diagnosed by echocardiography using Philips EPIQ7 Cand GE Vivid E95 in The first Hospital of China Medical University.The valve morphology,size,number,thickness,echo,attachment,opening and closing of the pulmonary valve,pulmonary artery,the size of right ventricle(RV)and the hemodynamics of CQPV were evaluated.Results 7 patients with CQPV were diagnosed by echocardiography.According to Hurwitz and Roberts' s classification from A to G,there were 1 in CQPV type A,4 in CQPV type B,and 2 in CQPV type E respectively.All 7 cases had abnormal valve function:5/7 with pulmonary regurgitation(PR),5/7 with pulmonic stenosis(PS),combined PR and PS in 3/7.Other cardiac abnormalities occurred in 2 of 7 cases.Eccentric bloodstream through pulmonary valve(PV)had an impact on the lateral wall of the main pulmonary artery(MPA)and formed a swirling flow with dilation of MPA in all of the 7 cases.4 cases with dilated right ventricle or right ventricular hypertrophy were documented.Conclusions Two-dimensional combined with three-dimensional Echcardiography can accurately show pulmonary leaflet numbers,morphology types and associated cardiac anomalies,and provide accurate evaluation of valve function,right ventricle and PA,have an important value to clinical diagnosis and treatment strategies for CQPV patients.
Objective To analyze the echocardiographic characteristics of congenital quadricuspid pulmonary valve(CQPV),to explore the leaflet morphology types,valve function and associated cardiac abnormalities,and to evaluate the value of echocardiography in diagnosing CQPV deformity.Methods We retrospectively analyzed the clinical data and echo images of patients with CQPV diagnosed by echocardiography using Philips EPIQ7 Cand GE Vivid E95 in The first Hospital of China Medical University.The valve morphology,size,number,thickness,echo,attachment,opening and closing of the pulmonary valve,pulmonary artery,the size of right ventricle(RV)and the hemodynamics of CQPV were evaluated.Results 7 patients with CQPV were diagnosed by echocardiography.According to Hurwitz and Roberts' s classification from A to G,there were 1 in CQPV type A,4 in CQPV type B,and 2 in CQPV type E respectively.All 7 cases had abnormal valve function:5/7 with pulmonary regurgitation(PR),5/7 with pulmonic stenosis(PS),combined PR and PS in 3/7.Other cardiac abnormalities occurred in 2 of 7 cases.Eccentric bloodstream through pulmonary valve(PV)had an impact on the lateral wall of the main pulmonary artery(MPA)and formed a swirling flow with dilation of MPA in all of the 7 cases.4 cases with dilated right ventricle or right ventricular hypertrophy were documented.Conclusions Two-dimensional combined with three-dimensional Echcardiography can accurately show pulmonary leaflet numbers,morphology types and associated cardiac anomalies,and provide accurate evaluation of valve function,right ventricle and PA,have an important value to clinical diagnosis and treatment strategies for CQPV patients.
引文
[1] HURWITZ L E,ROBERTS W C.Quadricuspid semilunar valve[J].Am J Cardiol,1973,31(5):623-626.
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[3] BAUMGARTNER H,HUNG J,BERMEJO J,et al.Echocardiographic assessment of valve stenosis:EAE/ASE recommendations for clinical practice[J].Eur J Echocardiogr,2009,10(1):1-25.
[4] HEDAYAT K M,SHARP E,WEINHOUSE E,et al.A quadricuspid pulmonic valve diagnosed in a live newborn by two-dimensional echocardiography[J].Pediatr Cardiol,2000,21(3):279-281.
[5] YOON S J,PARK J K,OH S.An incidentally found unusual quadricuspid pulmonary valve with transthoracic echocardiography[J].Eur J Echocardiogr,2011,12(7):489.
[6] HADEED K,HASCOET S,AMADIEU R,et al.3Dtransthoracic echocardiography to assess pulmonary valve morphology and annulus size in patients with Tetralogy of Fallot[J].Arch Cardiovasc Dis,2016,109(2):87-95.
[7]李东东,马春燕,李光源.超声心动图诊断肺动脉瓣四叶畸形合并主肺动脉扩张2例[J].中国超声医学杂志,2017,33(7):620.
[2] ZOGHBI W A,ADAMS D,BONOW R O,et al.Recommendations for noninvasive evaluation of native valvular regurgitation:A report from the american society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance[J].J Am Soc Echocardiogr,2017,30(4):303-371.
[3] BAUMGARTNER H,HUNG J,BERMEJO J,et al.Echocardiographic assessment of valve stenosis:EAE/ASE recommendations for clinical practice[J].Eur J Echocardiogr,2009,10(1):1-25.
[4] HEDAYAT K M,SHARP E,WEINHOUSE E,et al.A quadricuspid pulmonic valve diagnosed in a live newborn by two-dimensional echocardiography[J].Pediatr Cardiol,2000,21(3):279-281.
[5] YOON S J,PARK J K,OH S.An incidentally found unusual quadricuspid pulmonary valve with transthoracic echocardiography[J].Eur J Echocardiogr,2011,12(7):489.
[6] HADEED K,HASCOET S,AMADIEU R,et al.3Dtransthoracic echocardiography to assess pulmonary valve morphology and annulus size in patients with Tetralogy of Fallot[J].Arch Cardiovasc Dis,2016,109(2):87-95.
[7]李东东,马春燕,李光源.超声心动图诊断肺动脉瓣四叶畸形合并主肺动脉扩张2例[J].中国超声医学杂志,2017,33(7):620.