摘要
目的探讨左冠状动脉异常起源于肺动脉的临床诊断方法。方法收集本院2000年2月至2007年2月左冠状动脉异常起源于肺动脉患儿22例，分为婴儿组（年龄≤1岁，n=10）和少儿组（年龄〉1岁且≤15岁，n=12），回顾性分析临床表现、心电图和经胸超声心动图表现。其中心电图主要分析如下特征：（1）I导联Q波和T波倒置，（2）aVL导联异常Q波和T波倒置，（3）V5-6导联Q波，（4）V4-6导联T波倒置或ST段变化，（5）左心室肥大。经胸超声心动图主要分析如下特点：（1）左冠状动脉与肺动脉的连接，（2）肺动脉内逆向的多普勒血流，（3）左心室乳头肌的回声强度，（4）右冠状动脉扩张，（5）室壁和室隔间侧支循环信号。结果胸片示心影增大（18／22）、心电图示aVL导联异常Q波和T波倒置（17／22）、超声心动图示汇入肺动脉的逆向多普勒血流（20／22）、前外侧乳头肌强回声（17／22）和侧支循环信号（16／22）在两组患儿中的出现率均很高，差异无统计学意义（P〉0．05）；婴儿组的临床症状和心电图示V56导联Q波、IQ波和T波倒置的出现率均显著高于少儿组（P〈0．05）；婴儿组右冠状动脉扩张的出现率要显著低于少儿组（P〈0．05）。结论婴儿和少儿患者的诊断特点不完全相同，胸部X线片示心影增大、心电图示aVL导联异常Q波和T波倒置对本病诊断有重要的提示作用，而超声心动图示逆向汇入肺动脉的彩色多普勒血流、前外侧乳头肌强回声和侧支循环信号等间接征象强烈提示本病的诊断，结合临床病史、心电图和超声心动图检查可以确诊本病。
Objective To discuss the diagnostic methods and features of anomalous origin of the left coronary artery from the pulmonary artery （ALCAPA）. Methods A total of 22 cases of ALCAPA hospitalized between 2000 and 2007 were recruited and divided into infant group （age ≤ 1 year, n = 10） and older children group （age 〉 1 year, n = 12）. The patients＇ history, electrocardiography （ECG） and echocardiography were reviewed and analyzed retrospectively. ECGs were analyzed as follows ： （ 1 ） Q wave and T wave inversion in lead I, （2） Abnormal Q wave and T wave inversion in lead aVL, （3） Q wave in lead V5-6, （4）T wave inversion and ST changes in lead V4-6, （5）LV hypertrophy. Echocardiograms were analyzed as follows ： （ 1 ） Continuity of the left coronary artery （LCA） and pulmonary artery （PA） , （2） Retrogade shunt into PA, （ 3 ） Increased papillary muscle echodensity, （4） Right coronary artery （RCA） dilation, （5）Collateral signals within the ventricular septum. Results The presence of cardiomegaly in X- ray film（18/22）, aVL QT pattern in ECG（ 17/22）, retrograde color Doppler flow into pulmonary artery （20/22）, anterior lateral papillary echogenic （17/22）and collateral vessel signals （16/22） in echocardiography were high in both groups （P 〉 0.05）. The presence of clinical symptoms and abnormal Q wave in leads I and V5-6 in ECG were significantly higher in the infant group than in the older children group （ P 〈 0. 05 ）. But the presence of right coronary artery dilation was significantly lower in the infant group than in the older children group （P 〈 0. 05）. Conclusion Different diagnostic features were found in infant and older children patients. With combination of patient history, electrocardiogram and echocardiogram, accurate diagnosis could be obtained in most pediatric patients with ALCAPA.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2008年第12期881-884,共4页
Chinese Journal of Pediatrics
