完全性肺静脉异位引流中引流位置及梗阻部位规律性的CTA探讨

目的探讨完全性肺静脉异位引流(TAPVC)引流位置及梗阻部位的规律性,以提高对TAPVC的认识及诊断水平。方法回顾性分析已确诊的70例TAPVC患儿的CT血管造影(CTA)资料,总结其引流位置及梗阻部位的规律。结果70例TAPVC中,心上型42例,心内型13例,心下型8例,混合型7例。42例心上型TAPVC中,37例肺静脉引流至头臂静脉,2例经垂直静脉直接引流入上腔静脉,2例分别引流至头臂静脉与上腔静脉,1例分别引流至头臂静脉与奇静脉。13例心内型TAPVC中,10例肺静脉引流至冠状静脉窦,3例直接引流入右心房。8例心下型TAPVC中,4例引流至门静脉,3例引流至肝静脉,1例引流至下腔静脉。7例混合型TAPVC中,5例为心上型+心内型的组合。肺静脉回流梗阻(PVO)30例(42.9%),PVO的发生率依次为心下型(87.5%)、心上型(52.4%)、混合型(14.3%)、心内型(0)。95.4%的心上型梗阻发生在垂直静脉,50%的心下型因引流至门静脉导致PVO。结论TAPVC形态学复杂,但其引流部位及路径遵循一定规律性,PVO的发生率高,梗阻部位存在规律性。

CT Angiography Study on Regularity of Drainage Position and the Site of Obstruction of Total Anomalous Pulmonary Venous Connection

Objective To improve the recognition and diagnosis of total anomalous pulmonary venous connection(TAPVC).Methods CT angiography data of 70 patients with TAPVC were retrospectively analyzed,and the regularity of drainage position and the site of obstruction were summarized.Results Of 70 patients with TAPVC,42 cases were supracardiac,13 cases were cardiac,8 cases were infracardiac,and 7 cases were mixed type.In supracardiac TAPVC,the pulmonary vein connected to the innominate vein(n=37),the superior vena cava(n=2).The pulmonary vein respectively drained into the innominate vein and the superior vena cava(n=2)and the innominate vein and azygous vein(n=1).In cardiac TAPVC,the pulmonary vein drained into the coronary sinus in 10 patients.In the remaining 3 patients,the pulmonary vein was observed to drain directly into the right atrium.In infracardiac TAPVC,The pulmonary vein drained into the portal vein(n=4),the hepatic vein(n=3)and the inferior vena cava(n=1).In mixed TAPVC,5 cases had the combination of cardiac and supracardiac.Pulmonary venous obstruction(PVO)was found in 30(42.9%)of 70 patients in this group.The incidence of PVO was 87.5%(infracardiac),52.4%(supracardiac),14.3%(mixed type),and 0%(cardiac)respectively.The site of obstruction was located in the vertical vein in 95.4%patients with supracardiac.PVO results from connecting to the portal vein in 50%patients with infracardiac TAPVC.Conclusions The morphology of TAPVC was complex,but its drainage position and path follow certain regularity.The incidence of PVO was high,and the site of obstruction was regular.