超声心动图顺序分段诊断法与64排螺旋CT诊断肺动脉闭锁合并室间隔缺损

摘要

目的 探讨TTE顺序分段诊断法和64排螺旋CT术前诊断肺动脉闭锁(PA)伴室间隔缺损(VSD)的准确性.方法 对45例PA/VSD患儿于术前进行TTE和心脏MSCT检查,以手术结果为金标准,按心脏及大血管各解剖节段分别与手术所见对照,分析比较二者诊断效能的差异性.结果 与手术结果对照,TTE和MSCT对腔静脉、肺静脉与心房连接、心室位置与房室连接、心室水平分流、心室与大动脉连接的诊断准确率均为100％;TTE与MSCT诊断肺动脉发育情况及动脉导管未闭的敏感度、特异度及准确率差异均无统计学意义(P均＞0.05);而在诊断心房水平分流方面、侧支血管及冠状动脉异常起源方面,二者差异均有统计学意义(P均＜0.05).结论 TTE顺序分段诊断法及MSCT均能较准确诊断PA/VSD.TTE在心内分流方面的诊断准确度优于MSCT;而在诊断主-肺动脉间侧支血管及冠状动脉起源方面,MSCT优于TTE.%Objective To explore the accuracy of echocardiography with sequential segmental diagnosis andMSCT in the preoperative diagnosis of pulmonary atresia (PA) with ventricular septal defect (VSD).Methods A total of 45 children with PA/VSD underwent TTE and MSCT before operation.Set the surgery result as standard,the diagnostic efficiency of TTE and MSCT on every segment of heart and major vessels were analyzed and compared.Results Comparing with the operation results,the accuracy of TTE and MSCT were 100％,in diagnosis of the connection of cavity vein,pulmonary vein and atrials,the ventricular location and connection to atrials,ventricular level shunt and connection of ventricular and arteries.The difference of accuracy,sensitivity and specificity betweer TTE and MSCT in diagnosis of pulmonary development and patent ductus arteriosus were not statistically significant (all P＞0.05),however it was statistically significant on the diagnosis of shunt in atrial septa,collateral circulation and coronary artery origins aspects (all P＜0.05).Conclusion Both of TTE and MSCT can be used to diagnose the PA/VSD accurately.MSCT is more reliable to detect the coronary artery origin and the collaterals between aorta and pulmonary artery,and TTE with sequential segmental diagnosis is more sensitive to find small shunt in atrial septa,especially.