CAJ | 학술논문

目的探讨超声心动图对完全性肺静脉异位引流(TAPVC)的诊断价值及局限性.方法回顾性分析2009年6月至2011年12月在北京儿童医院经胸超声心动图检查及手术证实为TAPVC患儿44例,分析其超声心动图直接征象和间接征象,根据肺静脉回流途径的特点总结TAPVC亚型及回流中存在的变异,并与术中所见相比较.结果 TAPVC患儿超声心动图共同征象:直接征象为左心房偏小,左心房内无肺静脉入口,左心房后方可见由4支肺静脉汇合形成的共同肺静脉干;间接征象为右心房、右心室重度增大,彩色多普勒血流成像示心房水平完全的右向左分流信号.44例TAPVC患儿中心上型28例(63.6%,28/44)、心内型12例(27.3%,12/44)、心下型1例(2.3%,1/44)、混合型3例(6.8%,3/44).心上型可根据回流途径分为3种亚型,分别为左行(26例)、双行(1例)、直行(1例)亚型;心内型可分为2种亚型,分别为回流冠状静脉窦(10例)、回流右心房(2例)亚型;心下型(1例)无亚型;混合型走行较复杂,2种亚型均为3+1型(3例).肺静脉回流途径狭窄、肺静脉分支异常为较常见的变异.超声诊断回流部位准确率达97.7%(43/44),回流途径准确率达93.2%(41/44).结论超声心动图是诊断TAPVC最为简便、快捷的方法.诊断准确率高,且可明确分型.肺静脉回流途径的走行及变异为超声心动图诊断TAPVC难点.
목적탐토초성심동도대완전성폐정맥이위인류(TAPVC)적진단개치급국한성.방법회고성분석2009년6월지2011년12월재북경인동의원경흉초성심동도검사급수술증실위TAPVC환인44례,분석기초성심동도직접정상화간접정상,근거폐정맥회류도경적특점총결TAPVC아형급회류중존재적변이,병여술중소견상비교.결과 TAPVC환인초성심동도공동정상:직접정상위좌심방편소,좌심방내무폐정맥입구,좌심방후방가견유4지폐정맥회합형성적공동폐정맥간;간접정상위우심방、우심실중도증대,채색다보륵혈류성상시심방수평완전적우향좌분류신호.44례TAPVC환인중심상형28례(63.6%,28/44)、심내형12례(27.3%,12/44)、심하형1례(2.3%,1/44)、혼합형3례(6.8%,3/44).심상형가근거회류도경분위3충아형,분별위좌행(26례)、쌍행(1례)、직행(1례)아형;심내형가분위2충아형,분별위회류관상정맥두(10례)、회류우심방(2례)아형;심하형(1례)무아형;혼합형주행교복잡,2충아형균위3+1형(3례).폐정맥회류도경협착、폐정맥분지이상위교상견적변이.초성진단회류부위준학솔체97.7%(43/44),회류도경준학솔체93.2%(41/44).결론초성심동도시진단TAPVC최위간편、쾌첩적방법.진단준학솔고,차가명학분형.폐정맥회류도경적주행급변이위초성심동도진단TAPVC난점.
Objective To assess the value and limitation of echocardiography in the diagnosis of total anomalous pulmonary venous connection (TAPVC).Methods Forty-four cases of pediatric TAPVC patients in Beijing Children′s Hospital from June 2009 to December 2011 were retrospectively analyzed.The echocardiography characteristics including direct and indirect signs,described the subtype and pulmonary vein anomaly according to the characteristics of drainage path were ummarized and compared with surgical treatment .Results All the 44 patients with confirmed TAPVC were included in this study .The common clinical presentations of the patients included:the direct signs were the smaller left atrium ,no entrance of pulmonary vein in the left atrium and four veins forming a common confluence just beside it;the indirect signs included enlargement of right atrium and right ventricle.Color Doppler flow imaging showed total interatrial right to left shunt .The specific types of TAPVC were as followed:supra-cardiac(63.6%,28/44),cardiac(27.3%,12/44),infra-cardiac(2.3%,1/44)and mixed(6.8%,3/44).The supra-cardiac type were further divided into 3 subtypes according to the drainage path:right and left veins forming a common confluence,then draining into vertical and innominate veins(26 cases);right and left pulmonary veins separately draining into superior vena cava(1 case);common confluence of pulmonary vein draining into superior vena cava through a vertical vein(1 case).The cardiac type were further divided into 2 subtypes:coronary sinus(10 cases),right atrium(2 cases).Infra-cardiac type had no subtype(1 case).Mixed type was more complex,both of the two subtypes were ′3+1′(3 cases).Drainage path stenosis and pulmonary vein anomaly were common variations.The diagnostic accuracy of drainage position and path in the study were 97.7%(43/44) and 93.2%(41/44).Conclusions Echocardiography is one of the simplest and most efficient modality for the diagnosis and typing of TAPVC ,with high diagnostic accuracy.The diagnosis of drainage path and variation of pulmonary veins are difficult .