CAJ | 학술논문

目的探讨超声心动图诊断与鉴别诊断主动脉左心室通道(aortico-left ventricular tunnel,AOLVT)的价值.方法回顾分析近20年来9例先心病AOLVT的超声心动图特点,总结诊断方法,分析超声容易漏诊、误诊的原因,提出鉴别诊断要点.结果 9例AOLVT中,除1例术前经CT检查确诊,因心脏骤停死亡外,其余8例全部完成外科手术治疗,术中确诊为AOLVT.超声于术前准确诊断5例,误诊4例,误诊病例中有3例诊断为主动脉瓣关闭不全,1例诊断为主动脉夹层瘤.分析全部患者超声心动图图像,AOLVT有其特有的结构及血流特点.最主要特点包括:二维超声显示主动脉瓣环与主动脉壁分离;彩色多普勒显示通道内收缩期左室流向主动脉花彩加速血流.此血流顺着通道走行,与其并行的主动脉瓣前向血流则不加速,色彩暗淡,舒张期则显示通道内由主动脉反流向左室的花彩加速血流.本病合并主动脉瓣病变时容易误诊为单纯主动脉瓣病变.8例手术患者中有7例术后6个月左室内径明显回缩(P＜0.001),左室射血分数提高(P＜0.001),仅1例行主动脉瓣机械瓣置换术患者术后心功能无明显恢复,2个月后因机械瓣瓣周漏死亡.结论 AOLVT诊断主要依赖超声心动图.提高对这类畸形的认识,研究其结构及血流动力学特点.可以提高本病的早期发现率及诊断的准确性.
목적 탐토초성심동도진단여감별진단주동맥좌심실통도(aortico-left ventricular tunnel,AOLVT)적개치.방법회고분석근20년래9례선심병AOLVT적초성심동도특점,총결진단방법,분석초성용역루진、오진적원인,제출감별진단요점.결과 9례AOLVT중,제1례술전경CT검사학진,인심장취정사망외,기여8례전부완성외과수술치료,술중학진위AOLVT.초성우술전준학진단5례,오진4례,오진병례중유3례진단위주동맥판관폐불전,1례진단위주동맥협층류.분석전부환자초성심동도도상,AOLVT유기특유적결구급혈류특점.최주요특점포괄:이유초성현시주동맥판배여주동맥벽분리;채색다보륵현시통도내수축기좌실류향주동맥화채가속혈류.차혈류순착통도주행,여기병행적주동맥판전향혈류칙불가속,색채암담,서장기칙현시통도내유주동맥반류향좌실적화채가속혈류.본병합병주동맥판병변시용역오진위단순주동맥판병변.8례수술환자중유7례술후6개월좌실내경명현회축(P＜0.001),좌실사혈분수제고(P＜0.001),부1례행주동맥판궤계판치환술환자술후심공능무명현회복,2개월후인궤계판판주루사망.결론 AOLVT진단주요의뢰초성심동도.제고대저류기형적인식,연구기결구급혈류동역학특점.가이제고본병적조기발현솔급진단적준학성.
Objective To explore the value of echocardiography on diagnosis and differential diagnosis of aortico-left ventricular tunnel(AOLVT).Methods Echocardiographic features of 9 patients with AOLVT were reviewed and analyzed.The diagnosis methodology was summarized;the reasons for missed diagnosis and misdiagnosis by echocardiography were analyzed.Results Among 9 patients with AOLVT,one was diagnosed through CT examination prior to the operation and died from the cardiac arrest.The others all received the surgical operation and were diagnosed as AOLVT.Five patients were accurately diagnosed by echocardiography prior to the operation,4 patients were misdiagnosed,in which 3 patients were diagnosed as aortic valve regurgitation,one patient was diagnosed as aortic dissecting aneurysm.The diameter of left ventricle(LV)decreased and LV ejection fraction increased distinctively for 7 operated patients(P＜0.001)in six months after operation.Only one operated patient failed to recover from the LV dysfunction and died of aortic valve perivalvular leak in two monthes.Conclusions The diagnosis of the AOLVT mainly depends on the echocardiography.By enhancing the understanding on such disease and investigating on the structure and hemodynamics will be contributive to the accurate diagnosis of echocardiography.