经胸超声心动图诊断儿童肺静脉异位连接

目的 探讨儿童肺静脉异位连接的超声表现以及经胸超声心动图(TTE)诊断价值.方法 回顾性分析经手术证实的31例肺静脉异位连接患儿,其中男22例,女9例,年龄22天～10岁,完全型肺静脉异位连接(TAPVC)18例,部分型肺静脉异位连接(PAPVC)13例.结果 31例APVC在TTE中均有右心负荷增加表现.18例TAPVC的解剖分型为心上型9例(50%),心内型9例(50%),16例(88.89%)经胸超声心动图诊断与手术结果完全或基本符合,2例(11.11%)误诊为部分型房室间隔缺损.13例PAPVC的解剖分型为心内型12例(92.31%),心上型1例(7.69%),均合并房间隔缺损,其中9例(69.23%)合并静脉窦型房间隔缺损;9例(69.23%)TTE诊断与手术结果完全或基本符合,4例(30.67%)误诊为单纯房间隔缺损.结论 超声心动图发现右心增大时,无论是否伴有房间隔缺损,均应注意常规检查4条肺静脉入口位置及血流方向.

Transthoracic echocardiographic diagnosis of anomalous pulmonary venous connection in children ZHANG Jing, BAI Yong-hong *,

Objective To assess the value of transthoracic echocardiography (TTE) in detection of anomalous pulmonary venous connection (APVC). Methods Thirty-one children with APVC, 22 males and 9 females, with the mean age of 22 days-10 years, including 18 total APVC (TAPVC) and 13 partial APVC (PAPVC), were diagnosed with TTE and then proved by surgery. Results Dilated right ventricle and right atrium were found in all patients. There were 9 supracardiac and 9 intracardiac cases respectively in the 18 cases of TAPVC, and 16 of them (88.89%) were identified by TTE, the rest 2 were misdiagnosed as partial atrioventricular septal defect. There were 12 intracardiac and 1 supracardiac types respectively in the 13 cases of PAPVC, all complicated with atrial septal defect (ASD), and 9 with sinus venosus ASD. Nine of the 13 cases with PAPVC (69.23%) were identified by TTE, the other 4 cases were misdiagnosed as ASD. Conclusion TTE is important to the diagnosis of APVC. For patients with dilated right heart, either complicated with ASD or not, the 4 pulmonary veins should be routinely explored to improve the accuracy of diagnosis for APVC.