左冠状动脉异常起源于肺动脉的超声诊断与手术矫治分析

目的结合左冠状动脉异常起源于肺动脉（ALCAPA）患者的CT表现及术中肉眼观察情况，探讨超声心动图对左冠状动脉起源于肺动脉的诊断价值。 方法回顾分析2008年1月至2015年5月武汉亚洲心脏病医院经手术证实的11例ALCAPA患者的超声心动图表现，并与术前CT和术中诊断比较。 结果11例患者CT检查与术中肉眼观察诊断结果相符，超声心动图表现与CT检查结果、术中肉眼诊断结果比较，8例诊断符合，3例诊断不符合，其中2例超声检查分别误诊为心内膜弹力纤维增生症（EFE）和右冠状动脉-肺动脉瘘（CPF），1例术前超声诊断为左冠状动脉扩张，二尖瓣前叶裂合并重度关闭不全，而CT检查及术中诊断发现存在2支冠状动脉左前降支，1支起源于左冠状动脉，另一支起源于肺动脉。 结论超声心动图可及时、准确诊断ALCAPA，但对明确心腔外的血管走行、起源有一定局限性，需结合CT等其他影像检查方法，进一步明确冠状动脉的走行及发育，以评估手术适应证及预后，为临床提供更为精确的诊断依据。

The value of echocardiography in diagnosis and operation analysis of anomalous origin of left coronary artery from pulmonary artery

ObjectiveTo investigate the value of echocardiography in diagnosis of anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) , combined with the computed tomography (CT) examination and intraoperative diagnosis. MethodsThe echocardiographic images of 11 patients with ALCAPA confirmed by operation were analyzed, and were compared with CT and intraoperative diagnosis. ResultsThe results of echocardiography in 8 cases were consistent with those of CT and surgery. While 3 cases were inconsistent with those of CT and surgery. Two cases were misdiagnosed as right coronary-pulmonary fistula (CPF) and endocardial fibroelastosis (EFE) by echocardiography. One case was misdiagnosed as left coronary artery dilatation, anterior mitral cleft combined with severe regurgitation by echocardiography, and was diagnosed as double anterior descending artery (one was normal and the other originated from pulmonary artery) by CT and surgery. ConclusionsEchocardiography can diagnose ALCAPA timely and accurately, but there was limitation in the vessels outside of the heart, so echocardiography should be combined with CT and other imaging examination to clarify the coronary artery to assess the surgical indication and prognosis and provide the basis for the doctor's next treatment.