摘要
目的探讨超声心动图对儿童冠状动脉异常起源于肺动脉的诊断特点及方法,提高对本病的认知和早期诊断准确性。资料与方法回顾性分析2012年1月—2022年2月南京医科大学附属儿童医院25例经CT血管三维重建或数字减影血管造影等确诊为冠状动脉异常起源于肺动脉患儿的资料,并与超声心动图结果进行比较,评估超声对本病的诊断效能,分析漏、误诊原因。结果25例患儿中,左冠状动脉异常起源于肺动脉23例,右冠状动脉异常起源于肺动脉2例。超声诊断符合19例,漏诊1例,误诊5例,其中1例误诊为扩张型心肌病,2例误诊为肌部多发室间隔缺损,1例误诊为左冠状动脉肺动脉瘘,1例误诊为二尖瓣单组乳头肌。共同超声图像特点为一侧冠状动脉开口及走行异常伴对侧冠状动脉扩张、肺动脉内“窃血”征及室间隔肌壁间花彩血流信号。结论儿童冠状动脉异常起源于肺动脉的超声心动图表现具有特征性,超声心动图可作为临床诊断的首选检查,但需注意图像鉴别,必要时结合数字减影血管造影或CT血管成像检查,避免漏、误诊。
Purpose To explore the characteristics and methods of echocardiography in the diagnosis of anomalous origin of coronary artery from the pulmonary artery in children,and to improve the awareness and early diagnostic accuracy of anomalous origin of coronary artery from the pulmonary artery in children.Materials and Methods Twenty-five children with anomalous origin of coronary artery from the pulmonary artery diagnosed by CT three-dimensional reconstruction or digital subtraction angiography in Children’s Hospital of Nanjing Medical University from January 2012 to February 2022 were retrospectively analyzed,and compared with the results of echocardiography.The diagnostic value of ultrasound and the causes of misdiagnosis were evaluated and be further summarized.Results Among the 25 patients,23 cases were anomalous origin of the left coronary artery from the pulmonary artery,2 cases were anomalous origin of the right coronary artery from the pulmonary artery.Ultrasound diagnosis was consistent with 19 cases,1 case was missed diagnosed,and 5 cases were misdiagnosed.Among them,1 case was misdiagnosed as dilated cardiomyopathy,2 cases were misdiagnosed as muscular ventricular septal defect,1 case was misdiagnosed as left coronary pulmonary artery fistula,and 1 case was misdiagnosed as mitral valve single group papillary muscle.The common ultrasound features included an abnormal opening and course of one coronary artery,accompanied by contralateral coronary artery dilation,“steal”phenomenon within the pulmonary artery,and color flow signals between the myocardial walls of the interventricular septum.Conclusion Anomalous origin of coronary artery from the pulmonary artery in children have characteristic findings on echocardiography.Echocardiography can be used as the first choice for clinical diagnosis,but attention should be paid to the identification of images,if necessary,combined with digital subtraction angiography or CT angiography to avoid misdiagnosis.
作者
陈晔
唐颖
朱善良
刘慧
杨明
CHEN Ye;TANG Ying;ZHU Shanliang;LIU Hui;YANG Ming(Department of Ultrasound,Children's Hospital of Nanjing Medical University,Nanjing 210008,China;不详)
出处
《中国医学影像学杂志》
CSCD
北大核心
2023年第11期1140-1144,共5页
Chinese Journal of Medical Imaging
基金
2019年度南京市卫生科技发展专项资金项目(YKK19106)
南京医科大学科技发展基金面上项目(2015NJMU067)。
关键词
冠状动脉病变
超声心动描记术
侧支循环
肺动脉
儿童
Coronary artery disease
Echocardiography
Collateral circulation
Pulmonary artery
Children
