儿童迷走锁骨下动脉的超声心动图与CTA术前诊断价值及术后随访分析

目的 探讨超声心动图与CTA在儿童迷走锁骨下动脉（ASA）的术前诊断及术后随访中的临床价值。方法 选取我院经心胸外科手术证实的ASA患儿192例，应用超声心动图与CTA观察心内结构及血管畸形，同时应用CTA观察气管狭窄程度，比较超声心动图与CTA对儿童ASA的术前诊断情况，分析二者在术后6个月评估吻合口血流梗阻及气管狭窄程度的价值。结果 192例ASA患儿中，超声心动图准确诊断124例，准确率为64.6%，漏诊67例，误诊1例；CTA准确诊断174例，准确率为90.6%，漏诊2例，误诊16例。192例ASA患儿中，132例合并其他心内结构畸形，超声心动图准确诊断130例，准确率为98.5%，漏诊2例；CTA准确诊断82例，准确率为62.1%，漏诊50例。所有患儿术后均经超声心动图随访，其中81例行ASA移植术及Kommerell憩室切除术的患儿，术后左锁骨下动脉与左颈总动脉吻合口均无明显梗阻（流速<2.0 m/s）;2例仅行ASA移植术的患儿，术后左锁骨下动脉与左颈总动脉吻合口流速均稍增快（流速>2.0 m/s）;13例仅行Kommerell憩室切除术的患儿，术后2例降主动...

The diagnostic value and postoperative follow-up analysis of echocardiography and CTA in children with aberrant subclavian artery

Objective To analyze the preoperative diagnosis of aberrant subclavian artery (ASA) by echocardiography and CTA, and to evaluate the postoperative follow-up results. Methods Data of 192 childrens with ASA confirmed by cardiothoracic surgery were retrospectively analyzed. Results In 192 childrens, 189 cases were right aortic arch with aberrant left subclavian artery (RAA-ALCA). 3 cases were left aortic arch with aberrant right subclavian artery (LAA-ARLA). 132 cases combine with other common cardiac structural malformations. The common malformations included 96 cases of Kommerell diverticulum, 89 cases of atrial septal defect/patent foramen ovale, 51 cases of ventricular septal defect,20 cases of left superior vena cava remaining, 17 cases of patent ductus arteriosus. In 192 cases, echocardiography accurately diagnosed ASA in 124 cases (64.6%); 68 cases (35.4%) were misdiagnosed. A total of 174 cases (90.6%) were accurately diagnosed by CTA, and 18 cases (9.4%) were missed and misdiagnosed. In 132 cases complicated with other cardiac structural malformations, Echocardiography missed diagnosis of patent foramen ovale in 2 cases, 47 cases of atrial septal defect/patent foramen ovale and small ventricular septal defect were missed by CTA diagnosis. In the follow-up of 96 children who underwent vagal left subclavian artery transplantation or Kommerell diverticulectomy, 81 children who underwent vagal subclavian artery transplantation and Kommerell diverticulectomy had no obvious anastomotic obstruction, and 14 patients underwent CTA. Evaluated tracheal compression was less than preoperative.Conclusions Echocardiography and CTA in the preoperative diagnosis of ASA each have advantages and disadvantages, can respectively in the process of postoperative follow-up evaluation anastomotic and airway pressure situation, therefore, the joint multimodal inspections on echocardiography and CTA, can be more accurate diagnosis of ASA and merge heart abnormalities, as well as a more comprehensive evaluation of postoperative recovery effect.