摘要
目的:归纳总结左冠状动脉异常起源于肺动脉(ALCAPA)的超声心动图诊断、鉴别要点,分析婴儿型、成人型ALCAPA的直接及间接超声心动图征象,分析ALCAPA外科手术后短期及中远期超声心动图随访结果。方法:回顾性分析2009年8月至2018年2月阜外医院经超声心动图诊断ALCAPA并接受外科手术治疗的患者资料,总结患者的超声心动图典型征象,并在术后6个月内(近期)及术后12～60个月(中远期,中位随访时间31个月)分别对患者进行超声心动图随访。结果:经胸超声心动图诊断ALCAPA共73例,包括31例婴儿型ALCAPA,42例成人型ALCAPA。与婴儿型ALCAPA患者相比,术前成人型ALCAPA患者的右冠状动脉内径较宽,右冠状动脉/主动脉根部内径比值较大,经体表面积校正后的左心室舒张末期内径(LVEDD)较小,左心室射血分数(LVEF)较高,差异均有统计学意义(P均<0.05)。术后近期随访发现,婴儿型ALCAPA患者LVEF较术前明显提高,但仍低于成人型ALCAPA患者(P<0.05);两型患者LVEDD较术前均明显缩小,但两者间的差异无统计学意义(P>0.05)。术后中远期随访显示,婴儿型ALCAPA患者的LVEF进一步明显提高,与成人型ALCAPA患者差异无统计学意义(P>0.05);两型ALCAPA患者LVEDD均未进一步明显改善。两型ALCAPA患者在术前、术后短期及中远期随访中二尖瓣形态及二尖瓣反流量上的差异均无统计学意义(P均>0.05)。结论:超声心动图对ALCAPA诊断、鉴别诊断、分型及术后随访中均具有重要的临床价值,对及时、有效诊断疾病并制定手术治疗策略具有指导意义。
Objectives: To summarize echocardiographic features and differential diagnosis of anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA), evaluate the direct and indirect echocardiographic signs of infantile and adult ALCAPA, and analyze the echocardiographic results of short-term and long-term follow-up.Methods: This retrospective study analyzed clinical data of patients diagnosed with ALCAPA by echocardiography and underwent surgery in Fuwai Hospital from 2009 to 2018. Echocardiographic features of ALCAPA were summarized and all patients were followed-up at 6 month and 12-60 months(median follow up was 31 months) post operation.Results: 73 patients were included in the study, 31 cases in the infant group and 42 cases in the adult group. The right coronary artery diameter and right coronary artery/aortic diameter were significantly larger, left ventricular ejection fraction value was higher, while left ventricular end diastolic diameter(LVEDD, corrected by body surface area) was significantlysmaller in adult ALCAPA patients than in infant ALCAPA patients(all P<0.05). Short-term postoperative follow-up results showed that the left ventricular ejection fraction was still lower in infant ALCAPA group than in the adult ALCAPA group(P<0.05), but the LVEDD value(corrected by body surface area) was similar between two groups(P>0.05). Long term postoperative follow-up results showed that there was no significant difference in left ventricular ejection fraction and LVEDD between the two groups(P>0.05). There were no significant differences in mitral valve morphology and mitral regurgitation flow between two groups at preoperative, postoperative, and during the long-term follow-up.Conclusions: Transthoracic echocardiography can accurately diagnose and classify ALCAPA, thus plays an important role in the clinical treatment decision-making and postoperative follow-up.
作者
齐红霞
孙境
李慧
梁玉
朱振辉
QI Hongxia;SUN Jing;LI Hui;LIANG Yu;ZHU Zhenhui(Department of Ultrasonography,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)
出处
《中国循环杂志》
CSCD
北大核心
2019年第2期165-170,共6页
Chinese Circulation Journal
关键词
超声心动描记术
左冠状动脉异常起源肺动脉
先天性心脏病
echocardiography
anomalous origin of the left coronary artery from the pulmonary artery
congenital heart disease
