2024 年第 2 期 第 19 卷

超声心动图在评估完全型肺静脉异位引流合并限制型与非限制型房间隔交通中的应用价值分析

The application value of echocardiography in evaluating total anomalous pulmonary venous connection combined with restricted and unrestricted atrial septal defect

作者：莫莹丁文虹李刚王霄芳王强

英文作者：Mo Ying Ding Wenhong Li Gang Wang Xiaofang Wang Qiang

单位：首都医科大学附属北京安贞医院小儿心脏科，北京100029

英文单位：Pediatric Cardiac Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：完全型肺静脉异位引流；房间隔缺损；超声心动图

英文关键词：Completeanomalouspulmonaryvenousconnection;Atrialseptaldefect;Echocardiography

• 摘要：

• 目的  总结超声心动图在评估完全型肺静脉异位引流(TAPVC)合并限制型与非限制型房间隔交通中的应用价值。方法  对2020年1月至2022年6月在首都医科大学附属北京安贞医院经外科手术确诊的49例TAPVC患者的超声心动图及临床资料进行回顾性分析。设定超声心动图测量房间隔交通≤5 mm为限制型房间隔交通，将患者分为限制组（23例）和非限制组（26例）。分别于术前及术后1、3个月行超声心动图检查，测量左心室内径（LVD）、右心室内径(RVD)、三尖瓣反流峰值压差(PTR)。分析并比较2组患者术前、术后心室内径和PTR的变化。结果  49例患者术前超声心动图诊断均与手术诊断一致，符合率100%。术前，限制组LVD、LVD/RVD比值明显低于非限制组，而PTR、RVD则明显高于非限制组，差异均有统计学意义(均P＜0.01)。术后1、3个月2组PTR、RVD和LVD/RVD比值比较差异均无统计学意义（均P＞0.05），限制组LVD小于非限制组［（19.3±4.2）mm比（22.3±4.6）mm、（22.6±3.8）mm比（25.9±3.7）mm］，差异均有统计学意义(均P＜0.05)。结论  超声心动图是诊断TAPVC的首选及准确的检查方法，早期诊断有利于尽早手术治疗，并能有效评价心脏容量改变及肺动脉高压下降情况，具有较高的临床应用价值。

• Objective  To summarize the value of echocardiography in evaluating total anomalous pulmonary venous connection (TAPVC) combined with restricted and unrestricted atrial septal defect. Methods  The echocardiography and clinical data of 49 patients with TAPVC admitted to Beijing Anzhen Hospital, Capital Medical University from January 2020 to June 2022 were retrospectively analyzed. Atrial septal defect ≤5 mm measured by echocardiography was set as the limit. Patients were divided into the restricted group (23 cases) and the unrestricted group (26 cases). Echocardiography was performed before surgery, 1 and 3 months after surgery, respectively. Left ventricular diameter (LVD) and right ventricular diameter (RVD) and tricuspid valve regurgitation maximum pressure gradient (PTR) were measured. The changes of ventricular diameter and PTR before and after operation were analyzed and compared between the two groups. Results  The preoperative echocardiographic diagnosis was consistent with the operative diagnosis in 49 cases, and the coincidence rate was 100%. Before surgery, LVD and LVD/RVD ratio in the restricted group were significantly lower than those in the unrestricted group, while PTR and RVD were significantly higher than those in the unrestricted group (all P＜0.01). There was no statistically significant difference in PTR, RVD, and LVD/RVD ratio between the two groups 1 and 3 months after surgery (all P＞0.05). The LVD of the restricted group was smaller than that of the unrestricted group 1 and 3 months after surgery［(19.3±4.2)mm vs (22.3±4.6)mm, (22.6±3.8)mm vs (25.9±3.7)mm］(both P＜0.05). Conclusion  ss  Echocardiography is the first choice and accurate method for the diagnosis of TAPVC. Early diagnosis is beneficial to early surgical treatment, and can effectively evaluate the change of cardiac volume and the decrease of pulmonary hypertension, which has high clinical application value.