超声心动图在儿童左心耳瘤诊治中的应用价值

目的探讨超声心动图在儿童左心耳瘤（LAAA）诊治中的应用价值。 方法回顾性选取首都医科大学附属北京儿童医院2016年3月至2021年3月经超声心动图诊断的LAAA患者9例，总结分析其临床一般资料、超声心动图表现以及治疗随访和预后结果。 结果9例LAAA患者中，男性4例，女性5例，年龄34 d~12岁11个月。二维超声图像可见左心室外侧囊状无回声结构，与左心房交通，LAAA长径为（32.3±12.9）mm，短径为（16.4±6.9）mm，彩色多普勒可见LAAA与左心房间血流信号往返，巨大LAAA可压迫左心室。9例患者中1例左心室侧壁受压，2例合并先天性心脏病，2例存在占位性病变（纵隔占位、肺部肿瘤各1例），1例存在二尖瓣狭窄伴关闭不全。9例均未见血栓形成，均为心包内型LAAA，无冠状动脉及肺静脉受压。1例患者因瘤体压迫左心室，手术切除LAAA，术后左心形态大小正常、功能良好。1例应用抗心律失常药物治疗，1例行纵隔肿物切除手术，LAAA均较前缩小。 结论LAAA罕见，超声心动图可在儿童时期准确诊断LAAA，判断有无血栓形成以及是否压迫邻近结构，并且有助于明确病因、评估治疗效果，具有较好的临床应用价值。

Value of echocardiography in diagnosis and treatment of left atrial appendage aneurysm in children

ObjectiveTo assess the value of echocardiography in the diagnosis and treatment of left atrial appendage aneurysm (LAAA) in children. MethodsNine children with LAAA diagnosed by echocardiography from March 2016 to March 2021 at Beijing Children's Hospital, Capital Medical University were retrospectively selected. We summarized and analyzed their clinical data, echocardiographic findings, treatment follow-up, and prognosis results. ResultsOf the nine patients with LAAA, four were male and five were female. They ranged in age from 34 days to 12 years and 11 months, and the reasons for presentation were cardiomegaly, atrial tachycardia, heart murmur, and mediastinal mass. Two-dimensional ultrasound showed a cystic anechoic structure in the lateral of the left ventricle, communicating with the left atrium, with a long diameter of (32.3±12.9) mm and a short diameter of (16.4±6.9) mm for LAAA, a round trip between LAAA and left atrial blood flow signals was observed by color Doppler, and giant LAAA could compress the left ventricle. One of the nine patients had compression of the lateral wall of the left ventricle, two had congenital heart disease, two had space-occupying lesions (one mediastinal mass and one pulmonary tumor), and one had mitral stenosis with insufficiency. There was no thrombosis, pericardial defect, or coronary artery and pulmonary vein compression. All were intrapericardial LAAAs. In one patient, the left ventricle was compressed due to the tumor, and the LAAA was surgically removed, and the shape, size, and function of the left heart were normal after surgery. One patient was treated with antiarrhythmic drugs and one patient underwent mediastinal tumor resection, and the LAAA was smaller than before in both cases. ConclusionLAAA is a rare cardiac malformation. Echocardiography can accurately diagnose LAAA in childhood, determine whether there is thrombosis and whether it compresses adjacent structures, and help to find the causes and evaluate the therapeutic effect.