乏氏窦瘤合并室间隔缺损对超声心动图诊断的影响

目的探讨未破型乏氏窦瘤合并室间隔缺损时两者发展的相互关系，以及乏氏窦瘤形成后对超声心动图诊断室间隔缺损成功率的影响。方法观察分析11例未破型乏氏窦瘤合并室间隔缺损患者的二维和彩色多普勒血流图像特征及其规律性，并与手术和／或心导管造影（左室造影＋升主动脉造影）对照。结果11例患者均为主动脉窦右冠窦瘤形成，未见破裂口，其中8例患者合并嵴上型室间隔缺损（其中6例为干下型缺损），另3例合并膜周部缺损。11例中3例造成右室流出道狭窄；4例合并主动脉瓣脱垂，造成不同程度的主动脉瓣关闭不全；1例合并肺动脉瓣位置变异。超声心动图明确诊断8例，2例VSD（干下型）和1例ASV漏诊。结论室间隔缺损可以促进乏氏窦瘤和主动脉瓣脱垂的病程进展；乏氏窦瘤会在一定程度上缓解室间隔缺损血流动力学的改变，同时也增加了超声心动图准确诊断室间隔缺损的难度。通过仔细、全面的观察，超声心动图可以对乏氏窦瘤合并室间隔缺损作出较准确的诊断，可以作为此类患者的首选诊断手段。

Influence of Sinus of Valsalva Aneurism Complicated with Ventricular Septal Defect on Echocardiographic Diagnosis Accuracy

Objective To evaluate the relationship between the sinus of Valsalva aneurism(SVA)and the ventricular septal defect(VSD),and to discuss the influence of the SVA on the echocardiography diagnosis accuracy for VSD.Methods Eleven patients with SVA and VSD were included in the study.The echocardiographic characteristics were analyzed and compared with the surgical findings and/or angiocardiography(left ventricular angiocardiography + ascending aortography).Results All patients with SVA were originated from right coronary sinus.In 11 cases,supracristal ventricular septal defect were observed in 8 cases(6 cases of them were stem-inferior type)and the other 3 cases were perimembranous VSD;right ventricular outflow tract stenosis was observed in 3 cases;aortic valve prolapse(AVP)and aortic insufficiency were observed in 4 cases;pulmonary valve position abnormality was observed in 1 case.In the 11 cases,UCG made correct diagnosis in 8 cases.Two cases of stem-inferior type VSD and 1 case of SVA were misdiagnosed.Conclusions VSD would accelerate the evolution of SVA and aortic valve prolapse.SVA would ameliorate the hemodynamics of patients with VSD to a certain extent,Thus,it also increases the difficulty of UCG for diagnosesis VSD simultaneously.In order to obtain the accurate diagnosis of the 2 diseases,it is very important to observe the echocardiographic characteristics.carefully and precisely.Echocardiography is an accurate and first choice modelity for the patients with the two diseases.