中国人成人先天性孤立性左室憩室的临床和影像诊断特点

目的　总结成人先天性左室憩室的临床 (和 )影像特点。方法　对 4例左室造影或 (和 )超高速CT(UFCT)、MRI确诊为成人先天性左室憩室患者的临床和影像特点进行分析。结果　临床无症状 ,然而均合并有冠心病 ,经左室造影确诊为先天性孤立性左室肌型憩室 ,其中 2例需UFCT和MRI补充诊断 ;二维超声心动图不仅与左室造影、MRI和UFCT的影像特征一致 ,可弥补左室造影中因左室影像重叠而对憩室观察缺陷的不足 ,而且其独特的多普勒 (Doppler)血流频谱 ,可与真、假室壁瘤鉴别 ,对憩室有确诊价值。结论　 (1)中国成人先天性左室憩室多为孤立性肌型憩室 ;临床多无症状 ,多合并有冠心病 ,甚至心肌梗死 ;左室造影有确诊价值 ,但有时需UFCT或MRI补充。 (2 )超声心动图不仅与MRI和UFCT影像特征一致 ,而且其独特的Doppler血流频谱 ,对左室肌型憩室有确诊价值。

Clinical and image features of congenital left ventricular diverticulum in adults of Chinese

Objective To summarize the clinical and image features of congenital left ventricular diverticulum in Chinese adults Methods The clinical and image features of congenital left ventricular (LV) diverticulum confirmed by left ventriculography (LVG) and/or magnetic resonance image (MRI) and ultra fast computerized tomography (UFCT) were analyzed and summarized in four Chinese adult patients who are all over 50 years old Results Clinically they did not have symptoms and complications associated with the LV diverticulum; however, they had coronary heart disease confirmed by coronary artery angiography with two case having history of myocardial infarction They were all diagnosed as having congenital isolated muscular diverticulum of left ventricle and confirmed by left ventriculography with the supplement of UFCT and MRI in 2 cases for the diagnosis The two dimensional echocardiographic features of the LV diverticulum were in agreement with the findings of LVG as well as MRI and UFCT in three patients and supplemental to the defect of LVG in visualizing the diverticulum when overlapped with left ventricular image In particular, the unique Doppler flow profile at the neck of the diverticulum can distinguish it from both ventricular aneurysm and pseudoaneurysm to show the diagnostic value for the left ventricular muscular diverticulum Conclusions (1) The congenital LV diverticulum in Chinese adults is usually of isolated and muscular type with clinical co existence of coronary heart disease or even myocardial infarction, but without clinical symptoms and complications associated with the diverticulum For the diagnosis of it, LVG has diagnostic value in the majority of the cases, but sometimes, UFCT and/or MRI are needed for supplement (2) The two dimensional echocardiographic features of LV diverticulum are not only in agreement with the findings of MRI and UFCT, but the unique Doppler flow profile at the neck of diverticulum is diagnostic for LV diverticulum of macular type