左冠状动脉异常起源于肺动脉的超声心动图诊断及随访

摘要

目的 探讨超声心动图在左冠状动脉异常起源于肺动脉(anomalous origin of the left coronary artery from the pulmonary artery,ALCAPA)诊断及随访中的应用价值.方法 回顾分析65例ALCAPA患者的资料,并进行随访.结果 超声心动图误诊4例,随访期2例婴儿型患者死亡.婴儿型患者术后短期、中期随访左室前后径明显缩小[(42.6±1.3) mm对(36.0±1.5)mm对(34.2±1.6)mm,P＜0.001],短期左心室收缩功能好转[(37.2-±3.0)％对(58.6±2.4),P＜0.0叭];成人型患者术后随访左室前后径明显减小(P＜0.001),二尖瓣反流情况改善.结论 超声心动图在ALCAPA早期诊断、术后评估及随访观察等方面具有重要的临床价值.%Objective To explore the value of the echocardiography in the diagnosis and follow-up evaluation of anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA).Methods Sixty-five patients with ALCAPA were reviewed retrospectively and followed-up after operations.Results Four cases were misdiagnosed.Two of infant-type patients were dead during the follow-up period.Postoperatively,echocardiography demonstrated that left ventricular end diastolic dimension (LVEDD) significantly narrowed in all infant-type patients in short-term and medial-term followed-up [(42.6 ± 1.3) mmvs (36.0 ± 1.5)mm vs (34.2 ± 1.6)mm,P ＜0.001],left ventricular ejection function(LVEF) improved in short-term follow-up[(30.0 ± 1.6) ％ vs (37.2 ± 3.0) ％,P =0.04] and significantly improved in a median follow-up[(37.2 ± 3.0)％ vs (58.6 ± 2.4)％,P ＜0.001].Adult-type also had a significant narrowed LVEDD (P ＜ 0.001),and none of the patients showed any significant residual mitral insufficiency.Conclusions Echocardiography has important clinical value in diagnosis of ALCAPA,postoperative and follow-up evaluation.