超声心动图诊断十字交叉心

目的 评估超声心动图对十字交叉心的诊断价值.方法 对我院收治的6例十字交叉心患儿的超声图像进行回顾性分析,总结超声图像特征,并将诊断结果与手术结果(4例)进行对比.结果 6例患儿均为心房正位,心室右袢,房室序接一致,心室大动脉连接关系包括右室双出口2例,完全型大动脉转位3例,连接一致1例.十字交叉心的超声心动图主要特征表现为:①不能同时完整显示四个心腔和二侧房室瓣;②探头角度从后向前连续性扫查显示一系列心尖或剑突下四腔心观,可于前后平面分别观察到左侧的左房连接右侧的左室,右侧的右房连接左侧的右室,两侧房室序接一致,但空间上呈交叉关系.③彩色多普勒显示房室瓣口跨瓣前向血流呈"十字交叉"且互不相混;④心室短轴观显示右室位于左前上方,左室位于右后下方,室间隔呈水平位;⑤容易合并三尖瓣和右室发育不良.与手术结果对照,超声准确诊断十字交叉心,合并畸形中漏诊双侧上腔静脉1例.结论 十字交叉心的重要特征是不能获取标准的四腔心观.心尖部或剑突下对各腔室及房室瓣进行从后向前的连续扫查时分别显示两侧心室流人道且心房心室交叉连接是本病的确诊依据.超声心动图能准确诊断这一疾病及合并心血管畸形.

Diagnosis of the criss-cross heart by echocardiography

Objective To explore the value of echocardiography in the diagnosis of the criss-cross heart. Methods The echocardiographic results of 6 patients with the criss-cross heart were reviewed retrospectively. The echocardiographic characteristics were analyzed and compared with the surgery results in 4 operated cases. Results The 6 cases were interpreted as representing a criss-cross heart with solitus atria,D-loop ventricles and concordant atrioventricular connections. The ventriculo-arterial alignments of 5 cases were abnormal including double outlet right ventricle with anterior aorta in 2 and transposition of the great arteries in 3 while 1 patient had concordant connection. The following principal characteristics were tilting the transducer from posterior to anterior could demonstrate the connection of the left-sided left atrium and the right-sided left ventricle through mitral valve at first. The more anterior angulation of the transducer then showed the right-sided right atrium was connected to the left-sided right ventricle through tricuspid imaging displayed the two atrial outflows crossed each other without mixing at atrioventricular valve level.right ventricle often occured. The echocardiographic diagnosis of the criss-cross heart and its associated cardiac abnormalities were confirmed by surgery in 4 cases except 1 persistent left superior vena cava was missed. Conclusions The invisibility of a standard 4-chamber view in any cut was very characteristic in the echocardiographic diagnosis of the criss-cross heart. The definitive appearance was the separate display of the two ventricular inlets and the crossed atrioventricular connections with each atrium emptying into the contralateral ventricle by continuous subxiphoid or apical scanning. The transthoracic echocardiography can diagnose this rare heart disease and associated cardiac abnormalities accurately.