彩色多普勒超声在单心室系列Fontan手术的应用

目的：探讨彩色多普勒超声在单心室系列Fontan手术前后的应用价值。方法：手术证实13例单心室。行右房－右室漏斗部、肺动脉连接术各1例，全腔静脉－肺动脉连接术6例，上腔静脉－肺动脉连接双相分流术5例。结果：术后彩超表现不同术式有如下不同表现，（1）主动脉弓短轴切面、右心房－肺动脉长轴切面见左、右或两侧上腔静脉下段与左、右或两侧肺动脉连接处分别为红、蓝血流，吻合处为花色血流束；（2）主动脉根部短轴切面，于肺动脉瓣上见右房内血流经右心耳进入肺动脉内；（3）心尖四腔切面，右房内隔膜两侧为红色血流，左侧进入单心室，右侧进入上腔静脉；（4）剑下四腔切面，右房外侧管状结构见蓝色血流束；（5）多普勒显示各切面吻合处为动、静脉血流频谱。结论：（1）彩超探查可明确单心室的诊断并为临床手术治疗及术后疗效的评价提供可靠依据；（2）各种Fontan术后彩超声像图有其特征性表现。

Application of CDFI in Single Ventricle with Series of Modified Fontan Operation

Objective:To explore the value of CDFI in the single ventricle with series of Fontan operation.Methods:Thirteen patients with different kinds of single ventricle which were comfirmed by operation.One case underwent right atrium to right ventricle conus connection,one case right atrium to pulmonary connection,6 cases underwent right atrium to total cavopulmonary connection,5 cases underwent superior vena cava with left,right or bilateral pulmonary artery connection(bidirected shunt operation).The operation results were detected by CDFI.Results:Different operation type resulted in different image characteristics.(1)In aortic arch short axis view and right atrium pulmonary artery long axis view,red and blue blood flows were seen in the lower segment of right,left or bilateral superior vena cavae or in left ,right or bilateral pulmonary connections and mosaic flow was detected at the anastomotic orifice.(2)In the aortic root short axis view,above the pulmonary valve,blood flow in the right atrium entered into the pulmonary artery through the right auricle.(3)In apical four chamber view,the blood flow at the both side of the septal membrane in right atrium was in red color and the left flow streamed down into the single ventricle,while the right into the superior vena cava.(4)In subcostal four chamber view,the blood flow in the vessel like structure at the lateral side of the right atrium displayed blue in color.(5)In all views of anastomic ostium,Doppler displayed artery vein flow spectrum.Conclusions:CDFI can provide accuracy and credibility for the single ventricle diagnosis before and after operation.The CDFI image after series of modified Fontan operation had its specific characteristics.