肺动脉异常起源于升主动脉的超声心动图诊断价值及漏误诊分析

目的探讨经胸超声心动图(TTE)在肺动脉异常起源于升主动脉(AOPA)的术前诊断价值及术后随访价值。方法回顾性分析我院经CTA或手术证实的17例AOPA患者的术前TTE表现特点及术后随访情况。结果 17例AOPA患者中,右肺动脉异常起源于升主动脉者13例,左肺动脉异常起源于升主动脉者4例;近端型14例,伴有其他心脏畸形者7例;术前超声漏诊2例(1例为AOPA合并主肺动脉间隔缺损,1例为AOPA合并法洛四联症)。15例包含术前漏诊1例行外科手术治疗,效果良好,术后超声心动图评估显示肺动脉吻合口通畅及肺动脉分支无明显狭窄,肺动脉压力明显下降;另2例包含术前漏诊1例成人患者因重度肺动脉高压未行手术治疗。结论 TTE能够清楚显示异常起源的肺动脉并评价其血流及肺动脉压力情况,在AOPA术前诊断及术后随访中起重要作用。

Application of transthoracic echocardiography in diagnosis and misdiagnosis of anomalous origin of pulmonary artery from ascending aorta

Objective: To investigate the value of transthoracic echocardiography (TTE) in preoperative diagnosis, the cause of misdiagnosis and postoperative follow-up of pulmonary artery abnormality originating from the ascending aorta (AOPA). Methods: The results of preoperative transthoracic echocardiography and postoperative follow-up of 17 patients with AOPA confirmed by CTA or surgery were retrospectively analyzed. Results: Among the 17 patients with AOPA, the right and the left pulmonary artery originated from ascending aorta were separately 76.47% (13/17) and 23.53% (4/17); The proximal type accounted for 82.3% (14/17), and other heart malformations accounted for 41.18% (7/17); 2 cases were missed (one was AOPA with primary pulmonary artery septal defect, the other was AOPA with Fallot tetralogy). The accuracy of ultrasound diagnosis of AOPA was 88.23% (15/17), confirmed by surgery. 15 cases of all patients underwent surgical treatment, and showed favourable effects. Echocardiography was used to evaluate the smoothness of the pulmonary anastomosis postoperatively, and exhibited that the pulmonary artery branch show no obvious stenosis and the pulmonary artery pressure was significantly decreased. Conclusion: The diagnosis of AOPA combined with complicated intracardiac malformation is more easily missed. The other intracardiac malformations and hemodynamic changes are clearly showed by echocardiography, which plays an important role in preoperative diagnosis and postoperative follow-up of AOPA. Transthoracic echocardiography is a non-invasive and accurate method for diagnosing AOPA.