顺序节段分析法在先天性右位心合并心内畸形中的诊断价值

目的提高超声心动图对心脏位置异常合并复杂心内畸形的诊断准确率。方法选择近年来在我院经手术或心血管造影证实的先天性右位心合并心内畸形患者42例，对其超声心动图检查结果进行回顾分析。结果手术证实本组先天性右位心分型：镜像右位心13例，右旋心29例；心内畸形：单心室10例，右室双出口8例，法洛四联症6例，完全性大动脉转位5例，矫正性大动脉转位4例，完全性房室间隔缺损4例，永存动脉干3例，肺动脉闭锁2例。超声误诊、漏诊的病例：3例完全性大动脉转位伴巨大室间隔缺损误诊为单心室；2例右室双出口误诊为法洛四联症；1例矫正性大动脉转位误诊为完全性大动脉转位；1例肺动脉闭锁误诊为永存动脉干；1例肺动脉闭锁超声漏诊左肺动脉缺如及多支体肺侧枝。结论超声心动图顺序节段法对绝大多数先天性右位心并心内畸形能作出准确诊断，但对某些极为复杂的病例心导管检查仍是明确诊断和手术条件的重要手段。

Sequential segmental analysis of congenital dextrocardia associated with complex abnormalities

ObjectiveTo discuss the diagnostic value of echocardiography for congenital dextrocardia patients associated with intracardiac abnormalities. MethodsForty two cases of congenital dextrocardia detected by echocardiography and proved by surgery or/and catheter were stu died retrospectively. ResultsThere were 13 cases of mirror image dextrocardia and 29 cases of dextroversion. The 42 patients involved 10 cases of single ventricle (SV), 8 cases of double outlet right ventricle (DORV), 6 cases of tetralogy of fallot (TOF), 5 cases of complete transposition of great arteries (TGA), 4 cases of correct TGA, 4 cases of complete atrioventficular septal defect (CAVSD), 3 cases of persistent truncus arterosus (PTA) and 2 cases of pulmonary atresia (PA). There were 3 cases of complete TGA with huge ventricular septal defect misdiagnosed as SV, two cases of DORV misdiagnosed as TOF, one case of correct TGA misdiagnosed as complete TGA, one case of PA misdiagnosed as PTA and another case of PA with systemic pulmonary collateral circulation misdiagnosed on echocardiography. ConclusionMost of the abnormalities in congenital dextrocardia patients could be analyzed properly through echocardiography with sequential segmental analysis while angiocardiography is necessary to some complex cases.